18D0893094 CLIA NUMBER - LONDON PEDIATRIC & ADOLESCENT MEDICINE

Laboratory Demographics

CLIA Number: 18D0893094

Facility Name: LONDON PEDIATRIC & ADOLESCENT MEDICINE

Facility Address:
378 THOMPSON POYNTER ROAD
LONDON, KY
ZIP 40741
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Facility Phone Number: 606 877-3990

Facility Type: Rural Health Clinic

Certificate Type: Microscopy

NPI Number: 1508918533

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	18D0893094
LAB Type	Rural Health Clinic
Facility Name	LONDON PEDIATRIC & ADOLESCENT MEDICINE
Street	378 THOMPSON POYNTER ROAD
City	LONDON
State	KY
ZIP	40741
Phone	606 877-3990
CertificateType	3
CertificateEffectiveDate	4/24/2023
CertificateExpirationDate	4/23/2025
FacilityType	PPMP

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