18D2000821 CLIA NUMBER - HAZARD ARH IMAGING CENTER LLC DBA MEDICAL MALL IMAGING CENTER

Laboratory Demographics

  • CLIA Code: 18D2000821
  • Facility Name: HAZARD ARH IMAGING CENTER LLC DBA MEDICAL MALL IMAGING CENTER
  • Facility Address: 210 BLACK GOLD BOULEVARD SUITE 101
    HAZARD, KY
    ZIP 41701
  • Facility Phone: 606 439-5057
  • Facility Type: Other - IMAGING CENTER
  • Facility Type: Waiver
  • Lab Director: KENNY HICKS
  • NPI Number: 1629306220
  • Taxonomy: 2085R0202X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 18D2000821
LAB Type Other - IMAGING CENTER
Facility Name HAZARD ARH IMAGING CENTER LLC DBA MEDICAL MALL IMAGING CENTER
Street 210 BLACK GOLD BOULEVARD SUITE 101
City HAZARD
State KY
ZIP 41701
Phone 606 439-5057
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/7/2023
Certificate Expiration Date 12/6/2025
Facility Type Other - IMAGING CENTER
Lab Director KENNY HICKS

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