18D2127165 CLIA NUMBER - LAKE CUMBERLAND PEDIATRICS, PLLC DBA LAKE CUMBERLAND PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 18D2127165
  • Facility Name: LAKE CUMBERLAND PEDIATRICS, PLLC DBA LAKE CUMBERLAND PRIMARY CARE
  • Facility Address: 268 ROLLING HILLS BLVD
    MONTICELLO, KY
    ZIP 42633
  • Facility Phone: 606 753-0293
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOSEPH BROWN
  • NPI Number: 1518406859
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 18D2127165
LAB Type Physician Office
Facility Name LAKE CUMBERLAND PEDIATRICS, PLLC DBA LAKE CUMBERLAND PRIMARY CARE
Street 268 ROLLING HILLS BLVD
City MONTICELLO
State KY
ZIP 42633
Phone 606 753-0293
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/10/2025
Certificate Expiration Date 3/9/2027
Facility Type Physician Office
Lab Director JOSEPH BROWN

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