51D2200928 CLIA NUMBER - DELTA LIFESTYLE LLC

Laboratory Demographics

  • CLIA Code: 51D2200928
  • Facility Name: DELTA LIFESTYLE LLC
  • Facility Address: 109 TOLLEY DRIVE
    BRIDGEPORT, WV
    ZIP 26330
  • Facility Phone: 304 623-6300
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARY E. HACKNEY
  • NPI Number: 1619579208
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 51D2200928
LAB Type Physician Office
Facility Name DELTA LIFESTYLE LLC
Street 109 TOLLEY DRIVE
City BRIDGEPORT
State WV
ZIP 26330
Phone 304 623-6300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/18/2024
Certificate Expiration Date 11/17/2026
Facility Type Physician Office
Lab Director MARY E. HACKNEY

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This page was last updated on: 9/29/2025