18D1052501 CLIA NUMBER - STONECREST FAMILY MEDICINE PLLC

Laboratory Demographics

CLIA Number: 18D1052501

Facility Name: STONECREST FAMILY MEDICINE PLLC

Facility Address:
101 STONECREST ROAD, SUITE 3
SHELBYVILLE, KY
ZIP 40065
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Facility Phone Number: 502 633-5565

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1659322808

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	18D1052501
LAB Type	Physician Office
Facility Name	STONECREST FAMILY MEDICINE PLLC
Street	101 STONECREST ROAD, SUITE 3
City	SHELBYVILLE
State	KY
ZIP	40065
Phone	502 633-5565
CertificateType	4
CertificateEffectiveDate	3/28/2024
CertificateExpirationDate	3/27/2026
FacilityType	Waiver

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