18D2099099 CLIA NUMBER - MINUTECLINIC DIAGNOSTIC OF KENTUCKY, LLC CLINIC 4779

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Laboratory Demographics

CLIA Number: 18D2099099

Facility Name: MINUTECLINIC DIAGNOSTIC OF KENTUCKY, LLC CLINIC 4779

Facility Address:
2311 LIME KILN ROAD
LOUISVILLE, KY
ZIP 40222
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Facility Phone Number: 401 770-3480

Facility Type: Other - LIMITED SERVICES HCC

Certificate Type: Waiver

NPI Number: 1578891057

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	18D2099099
LAB Type	Other - LIMITED SERVICES HCC
Facility Name	MINUTECLINIC DIAGNOSTIC OF KENTUCKY, LLC CLINIC 4779
Street	2311 LIME KILN ROAD
City	LOUISVILLE
State	KY
ZIP	40222
Phone	401 770-3480
CertificateType	4
CertificateEffectiveDate	7/21/2023
CertificateExpirationDate	7/20/2025
FacilityType	Waiver

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