44D0311073 CLIA NUMBER - BALLAD HEALTH MEDICAL ASSOC UROLOGY KINGSPORT

Laboratory Demographics

  • CLIA Code: 44D0311073
  • Facility Name: BALLAD HEALTH MEDICAL ASSOC UROLOGY KINGSPORT
  • Facility Address: 2204 PAVILION DRIVE #300
    KINGSPORT, TN
    ZIP 37660
  • Facility Phone: 423 246-4155
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. KURT ICK
  • NPI Number: 1568929818
  • Taxonomy: 2084P0800X - Psychiatry & Neurology

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CLIA Record

Field Name Field Value
CLIA Number 44D0311073
LAB Type Physician Office
Facility Name BALLAD HEALTH MEDICAL ASSOC UROLOGY KINGSPORT
Street 2204 PAVILION DRIVE #300
City KINGSPORT
State TN
ZIP 37660
Phone 423 246-4155
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 12/1/2024
Certificate Expiration Date 11/30/2026
Facility Type Physician Office
Lab Director DR. KURT ICK

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