18D0326808 CLIA NUMBER - PRIMARY CARE ASSOCIATES OF RUSSELL COUNTY

Laboratory Demographics

  • CLIA Code: 18D0326808
  • Facility Name: PRIMARY CARE ASSOCIATES OF RUSSELL COUNTY
  • Facility Address: 92 J P PETTY DRIVE, SUITE 300
    RUSSELL SPRINGS, KY
    ZIP 42642
  • Facility Phone: 270 866-7066
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. MILES K. GIBSON
  • NPI Number: 1295245025
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 18D0326808
LAB Type Physician Office
Facility Name PRIMARY CARE ASSOCIATES OF RUSSELL COUNTY
Street 92 J P PETTY DRIVE, SUITE 300
City RUSSELL SPRINGS
State KY
ZIP 42642
Phone 270 866-7066
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/3/2024
Certificate Expiration Date 11/2/2026
Facility Type Physician Office
Lab Director DR. MILES K. GIBSON

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