18D0923105 CLIA NUMBER - JACKSON PURCHASE PRIMARY CARE - CONVENIENT CARE CLINIC

Laboratory Demographics

  • CLIA Code: 18D0923105
  • Facility Name: JACKSON PURCHASE PRIMARY CARE - CONVENIENT CARE CLINIC
  • Facility Address: 1029 MEDICAL CENTER CIRCLE, SUITE 202
    MAYFIELD, KY
    ZIP 42066
  • Facility Phone: 270 251-4115
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. MARTY W. ODOM
  • NPI Number: 1710591656
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 18D0923105
LAB Type Physician Office
Facility Name JACKSON PURCHASE PRIMARY CARE - CONVENIENT CARE CLINIC
Street 1029 MEDICAL CENTER CIRCLE, SUITE 202
City MAYFIELD
State KY
ZIP 42066
Phone 270 251-4115
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/1/2024
Certificate Expiration Date 11/30/2026
Facility Type Physician Office
Lab Director DR. MARTY W. ODOM

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