51D2256451 CLIA NUMBER - ISHIMARU MEDICAL SERVICES CAROLINA AVENUE CLINIC

Laboratory Demographics

  • CLIA Code: 51D2256451
  • Facility Name: ISHIMARU MEDICAL SERVICES CAROLINA AVENUE CLINIC
  • Facility Address: 507 CAROLINA AVENUE
    CHESTER, WV
    ZIP 26034
  • Facility Phone: 304 224-3583
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: RICHARD J. DIAMOND
  • NPI Number: 1487399887
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 51D2256451
LAB Type Community Clinic
Facility Name ISHIMARU MEDICAL SERVICES CAROLINA AVENUE CLINIC
Street 507 CAROLINA AVENUE
City CHESTER
State WV
ZIP 26034
Phone 304 224-3583
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/24/2024
Certificate Expiration Date 3/23/2026
Facility Type Community Clinic
Lab Director RICHARD J. DIAMOND

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