18D2107556 CLIA NUMBER - PINEVILLE MEDICAL CLINIC

Laboratory Demographics

CLIA Number: 18D2107556

Facility Name: PINEVILLE MEDICAL CLINIC

Facility Address:
251 S PINE STREET
PINEVILLE, KY
ZIP 40977
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Facility Phone Number: 606 337-3500

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1932575784

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	18D2107556
LAB Type	Physician Office
Facility Name	PINEVILLE MEDICAL CLINIC
Street	251 S PINE STREET
City	PINEVILLE
State	KY
ZIP	40977
Phone	606 337-3500
CertificateType	4
CertificateEffectiveDate	1/15/2024
CertificateExpirationDate	1/14/2026
FacilityType	Waiver

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