COUNTY MED, LLC
NPI 1407580483
Clinic/Center - Primary Care in Blackstone, VA

Active since July 14, 2022CLIA 49D2273322 · Waiver
103 E BROAD ST, BLACKSTONE, VA 23824(434) 264-3221 Get Directions Write a Review

NPPES record last updated: August 1, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Dec 22, 2022, Jul 14, 2022 (2 updates tracked since 2022).

About County Med, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

COUNTY MED, LLC (NPI 1407580483) is a healthcare organization registered as a primary care in Blackstone, Virginia and active in the NPI registry since July 2022. The organization holds a CLIA Waiver certificate valid through December 11, 2026 and lists Shantel Latta, Owner, as its authorized official.

NPPES Registry Identity

NPI1407580483
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameCOUNTY MED, LLC
Location Address103 E BROAD STBlackstone, VA 23824-1815
Mailing AddressPo Box 635Blackstone, VA 23824-0635
Organization SubpartNo
Authorized OfficialShantel LattaOwner · (434) 294-3825
Enumeration DateJuly 14, 2022
Last NPPES UpdateAugust 1, 20232 updates tracked since enumeration
NPPES CertifiedAugust 1, 2023
NPI 1407580483 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
103 E BROAD ST, Blackstone, VA 23824

Other Identifiers 1

Medicaid30017485050002VA

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 49D2273322

County Med, LLC · Blackstone, VA
Active · expires Dec 11, 2026
CLIA Number49D2273322
Laboratory TypePractitioner Other
Certificate Effective DateDecember 12, 2024
Certificate Expiration DateDecember 11, 2026
Laboratory DirectorShantel L. Latta
Laboratory Phone(434) 264-3221
Laboratory LocationCounty Med, LLC103 E Broad St, Blackstone, VA 23824
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Dentist (General Practice)
103 E BROAD ST
BLACKSTONE, VA 23824
Nurse Practitioner (Family)
103 E BROAD ST
BLACKSTONE, VA 23824

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is County Med, LLC's NPI number?

The NPI number for County Med, LLC is 1407580483. It was assigned to this organization in the NPPES registry on July 14, 2022.

Where is County Med, LLC located?

County Med, LLC is located at 103 E Broad St, Blackstone, VA 23824. The listed phone number is (434) 264-3221.

What is County Med, LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Does County Med, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 49D2273322) is associated with this NPI, valid through December 11, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for County Med, LLC was last updated on August 1, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.