51D2293694 CLIA NUMBER - WEST LOGAN PRIMARY CARE LLC

Laboratory Demographics

  • CLIA Code: 51D2293694
  • Facility Name: WEST LOGAN PRIMARY CARE LLC
  • Facility Address: 947 OLD LOGAN ROAD
    LOGAN, WV
    ZIP 25601
  • Facility Phone: 304 831-0085
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: EVA L. STANLEY
  • NPI Number: 1730963604
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 51D2293694
LAB Type Practitioner Other
Facility Name WEST LOGAN PRIMARY CARE LLC
Street 947 OLD LOGAN ROAD
City LOGAN
State WV
ZIP 25601
Phone 304 831-0085
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/14/2023
Certificate Expiration Date 11/13/2025
Facility Type Practitioner Other
Lab Director EVA L. STANLEY

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