18D1079976 CLIA NUMBER - BHMG INTERNAL MEDICINE AND PEDIATRICS

Laboratory Demographics

  • CLIA Code: 18D1079976
  • Facility Name: BHMG INTERNAL MEDICINE AND PEDIATRICS
  • Facility Address: 100 PROVIDENCE WAY SUITE 200
    NICHOLASVILLE, KY
    ZIP 40356
  • Facility Phone: 859 260-5370
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MRS. CHENELLE LUSARDI
  • NPI Number: 1437320611
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 18D1079976
LAB Type Physician Office
Facility Name BHMG INTERNAL MEDICINE AND PEDIATRICS
Street 100 PROVIDENCE WAY SUITE 200
City NICHOLASVILLE
State KY
ZIP 40356
Phone 859 260-5370
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/9/2023
Certificate Expiration Date 12/8/2025
Facility Type Physician Office
Lab Director MRS. CHENELLE LUSARDI

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This page was last updated on: 9/29/2025