18D2196777 CLIA NUMBER - COMMONWEALTH COMMUNITY CARE CENTERS

Laboratory Demographics

  • CLIA Code: 18D2196777
  • Facility Name: COMMONWEALTH COMMUNITY CARE CENTERS
  • Facility Address: 154 NORTH LAKE DRIVE
    PRESTONSBURG, KY
    ZIP 41653
  • Facility Phone: 606 263-4283
  • Facility Type: Mobile Laboratory
  • Facility Type: Waiver
  • Lab Director: MR. BENJAMIN D. FERGUSON
  • NPI Number: 1568094670
  • Taxonomy: 207NS0135X - Dermatology

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 18D2196777
LAB Type Mobile Laboratory
Facility Name COMMONWEALTH COMMUNITY CARE CENTERS
Street 154 NORTH LAKE DRIVE
City PRESTONSBURG
State KY
ZIP 41653
Phone 606 263-4283
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/20/2024
Certificate Expiration Date 10/19/2026
Facility Type Mobile Laboratory
Lab Director MR. BENJAMIN D. FERGUSON

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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