18D0907597 CLIA NUMBER - MIDDLETOWN PEDIATRICS PLLC

Laboratory Demographics

  • CLIA Code: 18D0907597
  • Facility Name: MIDDLETOWN PEDIATRICS PLLC
  • Facility Address: 301 MIDDLETOWN PARK PLACE SUITE C
    MIDDLETOWN, KY
    ZIP 40243
  • Facility Phone: 502 244-9858
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. DANA J. DISTLER
  • NPI Number: 1164645834
  • Taxonomy: 2080A0000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 18D0907597
LAB Type Physician Office
Facility Name MIDDLETOWN PEDIATRICS PLLC
Street 301 MIDDLETOWN PARK PLACE SUITE C
City MIDDLETOWN
State KY
ZIP 40243
Phone 502 244-9858
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/11/2025
Certificate Expiration Date 5/10/2027
Facility Type Physician Office
Lab Director DR. DANA J. DISTLER

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