18D2150286 CLIA NUMBER - SOUTHEAST FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 18D2150286
  • Facility Name: SOUTHEAST FAMILY PRACTICE
  • Facility Address: 222 W TENNESSEE AVENUE
    PINEVILLE, KY
    ZIP 40977
  • Facility Phone: 606 499-5135
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MR. TRAMPAS S. NOLAN
  • NPI Number: 1033600416
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 18D2150286
LAB Type Physician Office
Facility Name SOUTHEAST FAMILY PRACTICE
Street 222 W TENNESSEE AVENUE
City PINEVILLE
State KY
ZIP 40977
Phone 606 499-5135
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/21/2024
Certificate Expiration Date 6/20/2026
Facility Type Physician Office
Lab Director MR. TRAMPAS S. NOLAN

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