Healthcare Provider Details

I. General information

NPI: 1891478376
Provider Name (Legal Business Name): ESSENTIAL HEALTH LABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 THIMBLE SHOALS BLVD UNIT D
NEWPORT NEWS VA
23606-4217
US

IV. Provider business mailing address

729 THIMBLE SHOALS BLVD UNIT D
NEWPORT NEWS VA
23606-4217
US

V. Phone/Fax

Practice location:
  • Phone: 757-528-6099
  • Fax: 757-273-8111
Mailing address:
  • Phone: 757-528-6099
  • Fax: 540-772-9157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. JACQUELINE CLEMMONS
Title or Position: CEO
Credential:
Phone: 910-431-1455