18D0998251 CLIA NUMBER - RUSSELL FAMILY MEDICAL CENTER

Laboratory Demographics

CLIA Number: 18D0998251

Facility Name: RUSSELL FAMILY MEDICAL CENTER

Facility Address:
404 STEVE DR
RUSSELL SPRINGS, KY
ZIP 42642
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Facility Phone Number: 270 866-3161

Facility Type: Federally Qualified Health Center

Certificate Type: Certificate of Compliance

NPI Number: 1437483815

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	18D0998251
LAB Type	Federally Qualified Health Center
Facility Name	RUSSELL FAMILY MEDICAL CENTER
Street	404 STEVE DR
City	RUSSELL SPRINGS
State	KY
ZIP	42642
Phone	270 866-3161
CertificateType	2
CertificateEffectiveDate	12/17/2023
CertificateExpirationDate	12/16/2025
FacilityType	Compliance

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