18D1001337 CLIA NUMBER - RCG PADUCAH SOUTH

Laboratory Demographics

CLIA Number: 18D1001337

Facility Name: RCG PADUCAH SOUTH

Facility Address:
1061 HUSBANDS ROAD
PADUCAH, KY
ZIP 42003
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Facility Phone Number: 270 442-5020

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1134221534

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	18D1001337
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	RCG PADUCAH SOUTH
Street	1061 HUSBANDS ROAD
City	PADUCAH
State	KY
ZIP	42003
Phone	270 442-5020
CertificateType	4
CertificateEffectiveDate	7/9/2022
CertificateExpirationDate	7/8/2024
FacilityType	Waiver

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