18D1003602 CLIA NUMBER - FAMILY MEDICAL SPECIALTY CLINIC

Laboratory Demographics

CLIA Number: 18D1003602

Facility Name: FAMILY MEDICAL SPECIALTY CLINIC

Facility Address:
12 JACKSON HEIGHTS DRIVE
JACKSON, KY
ZIP 41339
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Facility Phone Number: 606 693-0199

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1992863021

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	18D1003602
LAB Type	Physician Office
Facility Name	FAMILY MEDICAL SPECIALTY CLINIC
Street	12 JACKSON HEIGHTS DRIVE
City	JACKSON
State	KY
ZIP	41339
Phone	606 693-0199
CertificateType	4
CertificateEffectiveDate	8/20/2023
CertificateExpirationDate	8/19/2025
FacilityType	Waiver

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