18D2268456 CLIA NUMBER - RED MAPLE PEDIATRICS

Laboratory Demographics

  • CLIA Code: 18D2268456
  • Facility Name: RED MAPLE PEDIATRICS
  • Facility Address: 1621 NASHVILLE STREET STE 106
    RUSSELLVILLE, KY
    ZIP 42276
  • Facility Phone: (270) 946-1372
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. DANIELLE FOSTER
  • NPI Number: 1295461119
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 18D2268456
LAB Type Physician Office
Facility Name RED MAPLE PEDIATRICS
Street 1621 NASHVILLE STREET STE 106
City RUSSELLVILLE
State KY
ZIP 42276
Phone 2709461372
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/13/2024
Certificate Expiration Date 9/12/2026
Facility Type Physician Office
Lab Director DR. DANIELLE FOSTER

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This page was last updated on: 5/15/2026