15D0717576 CLIA NUMBER - HUNTINGBURG CLINIC OF MEMORIAL HOSPITAL

Laboratory Demographics

CLIA Number: 15D0717576

Facility Name: HUNTINGBURG CLINIC OF MEMORIAL HOSPITAL

Facility Address:
407 E 22ND ST
HUNTINGBURG, IN
ZIP 47542
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Facility Phone Number: 812 683-3612

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1417310566

Taxonomy: 261QD0000X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	15D0717576
LAB Type	Physician Office
Facility Name	HUNTINGBURG CLINIC OF MEMORIAL HOSPITAL
Street	407 E 22ND ST
City	HUNTINGBURG
State	IN
ZIP	47542
Phone	812 683-3612
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024