18D0320395 CLIA NUMBER - GRACE PRIMARY CARE, PLLC

Laboratory Demographics

  • CLIA Code: 18D0320395
  • Facility Name: GRACE PRIMARY CARE, PLLC
  • Facility Address: 6520 WEST HIGHWAY 22
    CRESTWOOD, KY
    ZIP 40014
  • Facility Phone: 502 241-8488
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: MR. RENU GEORGE
  • NPI Number: 1679058804
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 18D0320395
LAB Type Community Clinic
Facility Name GRACE PRIMARY CARE, PLLC
Street 6520 WEST HIGHWAY 22
City CRESTWOOD
State KY
ZIP 40014
Phone 502 241-8488
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/2/2025
Certificate Expiration Date 8/1/2027
Facility Type Community Clinic
Lab Director MR. RENU GEORGE

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