18D2080529 CLIA NUMBER - BLUEGRASS PEDIATRICS, PLLC

Laboratory Demographics

  • CLIA Code: 18D2080529
  • Facility Name: BLUEGRASS PEDIATRICS, PLLC
  • Facility Address: 242 BERGER ROAD
    PADUCAH, KY
    ZIP 42003
  • Facility Phone: 270 366-0960
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. JOHN M. ROACH
  • NPI Number: 1427478700
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 18D2080529
LAB Type Physician Office
Facility Name BLUEGRASS PEDIATRICS, PLLC
Street 242 BERGER ROAD
City PADUCAH
State KY
ZIP 42003
Phone 270 366-0960
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/9/2024
Certificate Expiration Date 7/8/2026
Facility Type Physician Office
Lab Director DR. JOHN M. ROACH

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