18D0322544 CLIA NUMBER - ST CLAIRE FAMILY MEDICINE- OWINGSVILLE

Laboratory Demographics

CLIA Number: 18D0322544

Facility Name: ST CLAIRE FAMILY MEDICINE- OWINGSVILLE

Facility Address:
632 SLATE AVENUE
OWINGSVILLE, KY
ZIP 40360
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Facility Phone Number: 606 783-6832

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1134180920

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	18D0322544
LAB Type	Other
Facility Name	ST CLAIRE FAMILY MEDICINE- OWINGSVILLE
Street	632 SLATE AVENUE
City	OWINGSVILLE
State	KY
ZIP	40360
Phone	606 783-6832
CertificateType	4
CertificateEffectiveDate	5/8/2023
CertificateExpirationDate	5/7/2025
FacilityType	Waiver

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