18D2127957 CLIA NUMBER - TRIPCO MEDICAL

Laboratory Demographics

CLIA Number: 18D2127957

Facility Name: TRIPCO MEDICAL

Facility Address:
111 DERRICK ST
HOPKINSVILLE, KY
ZIP 42240
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Facility Phone Number: 270 632-4515

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1770016941

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	18D2127957
LAB Type	Physician Office
Facility Name	TRIPCO MEDICAL
Street	111 DERRICK ST
City	HOPKINSVILLE
State	KY
ZIP	42240
Phone	270 632-4515
CertificateType	4
CertificateEffectiveDate	3/22/2023
CertificateExpirationDate	3/21/2025
FacilityType	Waiver

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