18D2113036 CLIA NUMBER - PREMISE HEALTH OF KENTUCKY MEDICAL, PSC

Laboratory Demographics

  • CLIA Code: 18D2113036
  • Facility Name: PREMISE HEALTH OF KENTUCKY MEDICAL, PSC
  • Facility Address: 80 PIN OAK
    SOMERSET, KY
    ZIP 42503
  • Facility Phone: 877 423-1330
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MS. SHAWNA SEXTON
  • NPI Number: 1023669652
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 18D2113036
LAB Type Physician Office
Facility Name PREMISE HEALTH OF KENTUCKY MEDICAL, PSC
Street 80 PIN OAK
City SOMERSET
State KY
ZIP 42503
Phone 877 423-1330
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/16/2024
Certificate Expiration Date 5/15/2026
Facility Type Physician Office
Lab Director MS. SHAWNA SEXTON

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