18D2047319 CLIA NUMBER - PREMISE HEALTH OF KENTUCKY MEDICAL, PSC

Home > CLIA Lookup > 18D2047319

Laboratory Demographics

CLIA Number: 18D2047319

Facility Name: PREMISE HEALTH OF KENTUCKY MEDICAL, PSC

Facility Address:
1600 NORTH MAIN STREET
HOPKINSVILLE, KY
ZIP 42240
Get Directions

Facility Phone Number: 270 707-1679

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1679826630

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	18D2047319
LAB Type	Physician Office
Facility Name	PREMISE HEALTH OF KENTUCKY MEDICAL, PSC
Street	1600 NORTH MAIN STREET
City	HOPKINSVILLE
State	KY
ZIP	42240
Phone	270 707-1679
CertificateType	4
CertificateEffectiveDate	9/21/2022
CertificateExpirationDate	9/20/2024
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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