18D2072005 CLIA NUMBER - JHI WOLFE COUNTY FAMILY MEDICAL CLINIC

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Laboratory Demographics

CLIA Number: 18D2072005

Facility Name: JHI WOLFE COUNTY FAMILY MEDICAL CLINIC

Facility Address:
202 PLUMMER
CAMPTON, KY
ZIP 41301
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Facility Phone Number: 606 668-7385

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1962823393

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	18D2072005
LAB Type	Federally Qualified Health Center
Facility Name	JHI WOLFE COUNTY FAMILY MEDICAL CLINIC
Street	202 PLUMMER
City	CAMPTON
State	KY
ZIP	41301
Phone	606 668-7385
CertificateType	4
CertificateEffectiveDate	1/23/2024
CertificateExpirationDate	1/22/2026
FacilityType	Waiver

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