18D2293434 CLIA NUMBER - LOGAN MEMORIAL WOUND CARE CENTER

Laboratory Demographics

  • CLIA Code: 18D2293434
  • Facility Name: LOGAN MEMORIAL WOUND CARE CENTER
  • Facility Address: 1623 NASHVILLE STREET MOB 3 SUITE 203
    RUSSELLVILLE, KY
    ZIP 42276
  • Facility Phone: 270 725-4506
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. GILLIAN J. STUART
  • NPI Number: 1699796334
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 18D2293434
LAB Type Physician Office
Facility Name LOGAN MEMORIAL WOUND CARE CENTER
Street 1623 NASHVILLE STREET MOB 3 SUITE 203
City RUSSELLVILLE
State KY
ZIP 42276
Phone 270 725-4506
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/8/2023
Certificate Expiration Date 11/7/2025
Facility Type Physician Office
Lab Director DR. GILLIAN J. STUART

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