51D2195980 CLIA NUMBER - PETERSBURG HIGH SCHOOL

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Laboratory Demographics

CLIA Number: 51D2195980

Facility Name: PETERSBURG HIGH SCHOOL

Facility Address:
207 VIKING DRIVE
PETERSBURG, WV
ZIP 26847
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Facility Phone Number: 304 257-1444

Facility Type: School/Student Health Service

Certificate Type: Waiver

NPI Number: 1033699087

Taxonomy: 261QC1500X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	51D2195980
LAB Type	School/Student Health Service
Facility Name	PETERSBURG HIGH SCHOOL
Street	207 VIKING DRIVE
City	PETERSBURG
State	WV
ZIP	26847
Phone	304 257-1444
CertificateType	4
CertificateEffectiveDate	1/14/2023
CertificateExpirationDate	1/13/2025
FacilityType	Waiver

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