18D1070630 CLIA NUMBER - OWENSBORO HEALTH MEDICAL GROUP FAMILY MEDICINE

Laboratory Demographics

CLIA Number: 18D1070630

Facility Name: OWENSBORO HEALTH MEDICAL GROUP FAMILY MEDICINE

Facility Address:
1213 NORTH MAIN STREET
BEAVER DAM, KY
ZIP 42320
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Facility Phone Number: 270 274-4771

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1194161984

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	18D1070630
LAB Type	Physician Office
Facility Name	OWENSBORO HEALTH MEDICAL GROUP FAMILY MEDICINE
Street	1213 NORTH MAIN STREET
City	BEAVER DAM
State	KY
ZIP	42320
Phone	270 274-4771
CertificateType	4
CertificateEffectiveDate	8/10/2023
CertificateExpirationDate	8/9/2025
FacilityType	Waiver

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