51D2307963 CLIA NUMBER - MARSHALL FAMILY MEDICINE (PROACT SITE)

Laboratory Demographics

  • CLIA Code: 51D2307963
  • Facility Name: MARSHALL FAMILY MEDICINE (PROACT SITE)
  • Facility Address: 800 20TH STREET
    HUNTINGTON, WV
    ZIP 25703
  • Facility Phone: 304 696-8700
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: DR. ZACHERY H. HANSEN
  • NPI Number: 1609359066
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 51D2307963
LAB Type Community Clinic
Facility Name MARSHALL FAMILY MEDICINE (PROACT SITE)
Street 800 20TH STREET
City HUNTINGTON
State WV
ZIP 25703
Phone 304 696-8700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/18/2024
Certificate Expiration Date 7/17/2026
Facility Type Community Clinic
Lab Director DR. ZACHERY H. HANSEN

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