18D2175587 CLIA NUMBER - BE WELL PROVIDERS, LLC

Laboratory Demographics

  • CLIA Code: 18D2175587
  • Facility Name: BE WELL PROVIDERS, LLC
  • Facility Address: 11824 RANSUM DRIVE, SUITE 100
    LOUISVILLE, KY
    ZIP 40243
  • Facility Phone: 502 338-0608
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: MR. JUSTIN B. WALLEN
  • NPI Number: 1568971950
  • Taxonomy: 261QM0850X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 18D2175587
LAB Type Practitioner Other
Facility Name BE WELL PROVIDERS, LLC
Street 11824 RANSUM DRIVE, SUITE 100
City LOUISVILLE
State KY
ZIP 40243
Phone 502 338-0608
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/25/2023
Certificate Expiration Date 11/24/2025
Facility Type Practitioner Other
Lab Director MR. JUSTIN B. WALLEN

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