18D2103208 CLIA NUMBER - PENDLETON FAMILY CARE, LLC

Laboratory Demographics

CLIA Number: 18D2103208

Facility Name: PENDLETON FAMILY CARE, LLC

Facility Address:
1412 NORTH RACE ST
GLASGOW, KY
ZIP 42141
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Facility Phone Number: 270 629-6334

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1417324252

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	18D2103208
LAB Type	Physician Office
Facility Name	PENDLETON FAMILY CARE, LLC
Street	1412 NORTH RACE ST
City	GLASGOW
State	KY
ZIP	42141
Phone	270 629-6334
CertificateType	4
CertificateEffectiveDate	10/7/2023
CertificateExpirationDate	10/6/2025
FacilityType	Waiver

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