18D2033406 CLIA NUMBER - FOOTHILLS HEALTH AND WELLNESS CLINIC

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Laboratory Demographics

CLIA Number: 18D2033406

Facility Name: FOOTHILLS HEALTH AND WELLNESS CLINIC

Facility Address:
108 12TH ST
CLAY CITY, KY
ZIP 40312
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Facility Phone Number: 606 663-9011

Facility Type: Mobile Laboratory

Certificate Type: Waiver

NPI Number: 1366713000

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	18D2033406
LAB Type	Mobile Laboratory
Facility Name	FOOTHILLS HEALTH AND WELLNESS CLINIC
Street	108 12TH ST
City	CLAY CITY
State	KY
ZIP	40312
Phone	606 663-9011
CertificateType	4
CertificateEffectiveDate	12/1/2023
CertificateExpirationDate	11/30/2025
FacilityType	Waiver

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