18D2034189 CLIA NUMBER - PENNYROYAL CENTER PRINCETON CLINIC

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Laboratory Demographics

CLIA Number: 18D2034189

Facility Name: PENNYROYAL CENTER PRINCETON CLINIC

Facility Address:
1350 US HIGHWAY 62 WEST
PRINCETON, KY
ZIP 42445
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Facility Phone Number: 270 365-2007

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1720454507

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	18D2034189
LAB Type	Community Clinic
Facility Name	PENNYROYAL CENTER PRINCETON CLINIC
Street	1350 US HIGHWAY 62 WEST
City	PRINCETON
State	KY
ZIP	42445
Phone	270 365-2007
CertificateType	4
CertificateEffectiveDate	12/19/2023
CertificateExpirationDate	12/18/2025
FacilityType	Waiver

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