18D2135310 CLIA NUMBER - OWENSBORO HEALTH MED GRP UNIFIRST CLINIC

Laboratory Demographics

CLIA Number: 18D2135310

Facility Name: OWENSBORO HEALTH MED GRP UNIFIRST CLINIC

Facility Address:
2801 UNIFIRST DRIVE
OWENSBORO, KY
ZIP 42301
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Facility Phone Number: 270 713-0478

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1760905616

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	18D2135310
LAB Type	Physician Office
Facility Name	OWENSBORO HEALTH MED GRP UNIFIRST CLINIC
Street	2801 UNIFIRST DRIVE
City	OWENSBORO
State	KY
ZIP	42301
Phone	270 713-0478
CertificateType	4
CertificateEffectiveDate	8/21/2023
CertificateExpirationDate	8/20/2025
FacilityType	Waiver

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