18D2240398 CLIA NUMBER - BROCK MEDICAL, LLC

Laboratory Demographics

CLIA Number: 18D2240398

Facility Name: BROCK MEDICAL, LLC

Facility Address:
60 FITZ GILBERT RD HAZARD
HAZARD, KY
ZIP 41701
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Facility Phone Number: 606 716-6017

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1366003550

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	18D2240398
LAB Type	Practitioner Other
Facility Name	BROCK MEDICAL, LLC
Street	60 FITZ GILBERT RD HAZARD
City	HAZARD
State	KY
ZIP	41701
Phone	606 716-6017
CertificateType	4
CertificateEffectiveDate	10/19/2023
CertificateExpirationDate	10/18/2025
FacilityType	Waiver

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