18D2106420 CLIA NUMBER - JACKSON PURCHASE PRIMARY CARE HICKMAN CLINIC

Laboratory Demographics

  • CLIA Code: 18D2106420
  • Facility Name: JACKSON PURCHASE PRIMARY CARE HICKMAN CLINIC
  • Facility Address: 2003 S 7TH STREET
    HICKMAN, KY
    ZIP 42050
  • Facility Phone: 270 236-3337
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: MS. BRANDI STACY
  • NPI Number: 1205494085
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 18D2106420
LAB Type Rural Health Clinic
Facility Name JACKSON PURCHASE PRIMARY CARE HICKMAN CLINIC
Street 2003 S 7TH STREET
City HICKMAN
State KY
ZIP 42050
Phone 270 236-3337
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/17/2023
Certificate Expiration Date 12/16/2025
Facility Type Rural Health Clinic
Lab Director MS. BRANDI STACY

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