18D2136786 CLIA NUMBER - ST CAMILLUS URGENT CARE- LEITCHFIELD

Laboratory Demographics

CLIA Number: 18D2136786

Facility Name: ST CAMILLUS URGENT CARE- LEITCHFIELD

Facility Address:
312 NORTH MAIN STREET
LEITCHFIELD, KY
ZIP 42754
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Facility Phone Number: 270 422-4110

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1700395654

Taxonomy: 363L00000X - Nurse Practitioner
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

CLIA Record

Field Name	Field Value
CLIA Number	18D2136786
LAB Type	Physician Office
Facility Name	ST CAMILLUS URGENT CARE- LEITCHFIELD
Street	312 NORTH MAIN STREET
City	LEITCHFIELD
State	KY
ZIP	42754
Phone	270 422-4110
CertificateType	4
CertificateEffectiveDate	9/15/2023
CertificateExpirationDate	9/14/2025
FacilityType	Waiver

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