51D2095079 CLIA NUMBER - MINGO COUNTY FAMILY WELLNESS CENTER LLC

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Laboratory Demographics

CLIA Number: 51D2095079

Facility Name: MINGO COUNTY FAMILY WELLNESS CENTER LLC

Facility Address:
872 RT 65
WILLIAMSON, WV
ZIP 25661
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Facility Phone Number: 304 475-3700

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1801283882

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	51D2095079
LAB Type	Practitioner Other
Facility Name	MINGO COUNTY FAMILY WELLNESS CENTER LLC
Street	872 RT 65
City	WILLIAMSON
State	WV
ZIP	25661
Phone	304 475-3700
CertificateType	4
CertificateEffectiveDate	4/29/2023
CertificateExpirationDate	4/28/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024