18D2074821 CLIA NUMBER - SPECIALTY PHYSICIAN ASSISTANT, LLC DBA RUSSELL FORK WALK-IN CLINIC

Laboratory Demographics

  • CLIA Code: 18D2074821
  • Facility Name: SPECIALTY PHYSICIAN ASSISTANT, LLC DBA RUSSELL FORK WALK-IN CLINIC
  • Facility Address: 17401 KY HIGHWAY 80 EAST
    ELKHORN CITY, KY
    ZIP 41522
  • Facility Phone: 606 754-7085
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NICHOL BURCHFIELD
  • NPI Number: 1528484037
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 18D2074821
LAB Type Physician Office
Facility Name SPECIALTY PHYSICIAN ASSISTANT, LLC DBA RUSSELL FORK WALK-IN CLINIC
Street 17401 KY HIGHWAY 80 EAST
City ELKHORN CITY
State KY
ZIP 41522
Phone 606 754-7085
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/17/2024
Certificate Expiration Date 3/16/2026
Facility Type Physician Office
Lab Director NICHOL BURCHFIELD

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