51D2314122 CLIA NUMBER - LAWRENCE MEDICAL GROUP / RENEGADE HEALTH

Laboratory Demographics

  • CLIA Code: 51D2314122
  • Facility Name: LAWRENCE MEDICAL GROUP / RENEGADE HEALTH
  • Facility Address: 182 MATHIS ADDITION
    MOUNT GAY, WV
    ZIP 25637
  • Facility Phone: 304 601-5549
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: PRINTESS J. LAWRENCE JR
  • NPI Number: 1952149676
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 51D2314122
LAB Type Practitioner Other
Facility Name LAWRENCE MEDICAL GROUP / RENEGADE HEALTH
Street 182 MATHIS ADDITION
City MOUNT GAY
State WV
ZIP 25637
Phone 304 601-5549
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/14/2024
Certificate Expiration Date 11/13/2026
Facility Type Practitioner Other
Lab Director PRINTESS J. LAWRENCE JR

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