18D2035214 CLIA NUMBER - FYI HEALTHCARE CLINIC, PLLC

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Laboratory Demographics

CLIA Number: 18D2035214

Facility Name: FYI HEALTHCARE CLINIC, PLLC

Facility Address:
1219 NORTH MAIN STREET, SUITE 101
BEAVER DAM, KY
ZIP 42320
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Facility Phone Number: 270 274-0638

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1619258498

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	18D2035214
LAB Type	Practitioner Other
Facility Name	FYI HEALTHCARE CLINIC, PLLC
Street	1219 NORTH MAIN STREET, SUITE 101
City	BEAVER DAM
State	KY
ZIP	42320
Phone	270 274-0638
CertificateType	4
CertificateEffectiveDate	1/12/2024
CertificateExpirationDate	1/11/2026
FacilityType	Waiver

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