18D0946965 CLIA NUMBER - MICKEY D ANDERSON, MD

Laboratory Demographics

  • CLIA Code: 18D0946965
  • Facility Name: MICKEY D ANDERSON, MD
  • Facility Address: 118 PATRIOT DRIVE, SUITE 203
    BARDSTOWN, KY
    ZIP 40004
  • Facility Phone: 502 348-5588
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. MICKEY D. ANDERSON
  • NPI Number: 1497728323
  • Taxonomy: 208600000X - Surgery

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CLIA Record

Field Name Field Value
CLIA Number 18D0946965
LAB Type Physician Office
Facility Name MICKEY D ANDERSON, MD
Street 118 PATRIOT DRIVE, SUITE 203
City BARDSTOWN
State KY
ZIP 40004
Phone 502 348-5588
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/8/2024
Certificate Expiration Date 6/7/2026
Facility Type Physician Office
Lab Director DR. MICKEY D. ANDERSON

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