18D2300365 CLIA NUMBER - JACKSON PURCHASE PRIMARY CARE - SOUTHSIDE CLINIC

Laboratory Demographics

  • CLIA Code: 18D2300365
  • Facility Name: JACKSON PURCHASE PRIMARY CARE - SOUTHSIDE CLINIC
  • Facility Address: 1206 PARIS RD SUITE B
    MAYFIELD, KY
    ZIP 42066
  • Facility Phone: 270 251-4115
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: MS. LINDSAY D. FULCHER
  • NPI Number: 1336314442
  • Taxonomy: 207RN0300X - Internal Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 18D2300365
LAB Type Community Clinic
Facility Name JACKSON PURCHASE PRIMARY CARE - SOUTHSIDE CLINIC
Street 1206 PARIS RD SUITE B
City MAYFIELD
State KY
ZIP 42066
Phone 270 251-4115
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/8/2024
Certificate Expiration Date 3/7/2026
Facility Type Community Clinic
Lab Director MS. LINDSAY D. FULCHER

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