18D2052036 CLIA NUMBER - RUSSELL COUNTY JAIL

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Laboratory Demographics

CLIA Number: 18D2052036

Facility Name: RUSSELL COUNTY JAIL

Facility Address:
228 BRIAN WALTERS DR
RUSSELL SPRINGS, KY
ZIP 42642
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Facility Phone Number: 270 858-6908

Facility Type: Other - JAIL MEDICAL UNIT

Certificate Type: Waiver

NPI Number: 1073936902

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	18D2052036
LAB Type	Other - JAIL MEDICAL UNIT
Facility Name	RUSSELL COUNTY JAIL
Street	228 BRIAN WALTERS DR
City	RUSSELL SPRINGS
State	KY
ZIP	42642
Phone	270 858-6908
CertificateType	4
CertificateEffectiveDate	1/4/2023
CertificateExpirationDate	1/3/2025
FacilityType	Waiver

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