18D2057675 CLIA NUMBER - KIOSK MEDICINE OF KENTUCKY, LLC

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Laboratory Demographics

CLIA Number: 18D2057675

Facility Name: KIOSK MEDICINE OF KENTUCKY, LLC

Facility Address:
5001 MUD LANE
LOUISVILLE, KY
ZIP 40229
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Facility Phone Number: 502 962-0710

Facility Type: Other - WALK IN HEALTHCARE CLINIC

Certificate Type: Waiver

NPI Number: 1407249717

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	18D2057675
LAB Type	Other - WALK IN HEALTHCARE CLINIC
Facility Name	KIOSK MEDICINE OF KENTUCKY, LLC
Street	5001 MUD LANE
City	LOUISVILLE
State	KY
ZIP	40229
Phone	502 962-0710
CertificateType	4
CertificateEffectiveDate	4/22/2023
CertificateExpirationDate	4/21/2025
FacilityType	Waiver

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