51D2246184 CLIA NUMBER - MOUNTAINEER FAMILY MEDICINE - CHARLESTON

Laboratory Demographics

  • CLIA Code: 51D2246184
  • Facility Name: MOUNTAINEER FAMILY MEDICINE - CHARLESTON
  • Facility Address: 5240 MACCORKLE AVE, SE
    CHARLESTON, WV
    ZIP 25304
  • Facility Phone: 304 487-3487
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. MOHAMAD S. KALOU
  • NPI Number: 1336632660
  • Taxonomy: 207RI0011X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 51D2246184
LAB Type Physician Office
Facility Name MOUNTAINEER FAMILY MEDICINE - CHARLESTON
Street 5240 MACCORKLE AVE, SE
City CHARLESTON
State WV
ZIP 25304
Phone 304 487-3487
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/21/2023
Certificate Expiration Date 12/20/2025
Facility Type Physician Office
Lab Director DR. MOHAMAD S. KALOU

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