18D2066377 CLIA NUMBER - THACKER FAMILY MEDICAL LLC

Laboratory Demographics

  • CLIA Code: 18D2066377
  • Facility Name: THACKER FAMILY MEDICAL LLC
  • Facility Address: 140 ADAMS LANE, SUITE 600-700
    PIKEVILLE, KY
    ZIP 41501
  • Facility Phone: 606 509-2000
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. CHADWARD L. THACKER
  • NPI Number: 1134898364
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 18D2066377
LAB Type Physician Office
Facility Name THACKER FAMILY MEDICAL LLC
Street 140 ADAMS LANE, SUITE 600-700
City PIKEVILLE
State KY
ZIP 41501
Phone 606 509-2000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/25/2025
Certificate Expiration Date 9/24/2027
Facility Type Physician Office
Lab Director DR. CHADWARD L. THACKER

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This page was last updated on: 9/29/2025