18D2126094 CLIA NUMBER - WESTERN KY MEDICAL

Laboratory Demographics

CLIA Number: 18D2126094

Facility Name: WESTERN KY MEDICAL

Facility Address:
609 HAMMOND DRIVE
HOPKINSVILLE, KY
ZIP 42240
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Facility Phone Number: 270 887-8333

Facility Type: Other - DRUG TREATMENT

Certificate Type: Waiver

NPI Number: 1619395605

Taxonomy: 261QM2800X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction.

CLIA Record

Field Name	Field Value
CLIA Number	18D2126094
LAB Type	Other - DRUG TREATMENT
Facility Name	WESTERN KY MEDICAL
Street	609 HAMMOND DRIVE
City	HOPKINSVILLE
State	KY
ZIP	42240
Phone	270 887-8333
CertificateType	4
CertificateEffectiveDate	2/21/2023
CertificateExpirationDate	2/20/2025
FacilityType	Waiver

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