44D0315280 CLIA NUMBER - MC KENZIE MEDICAL CENTER DBA HOMETOWN HEALTH CLINIC

Laboratory Demographics

CLIA Number: 44D0315280

Facility Name: MC KENZIE MEDICAL CENTER DBA HOMETOWN HEALTH CLINIC

Facility Address:
205 HOSPITAL DRIVE
MC KENZIE, TN
ZIP 38201
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Facility Phone Number: 731 352-7907

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1245401231

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	44D0315280
LAB Type	Physician Office
Facility Name	MC KENZIE MEDICAL CENTER DBA HOMETOWN HEALTH CLINIC
Street	205 HOSPITAL DRIVE
City	MC KENZIE
State	TN
ZIP	38201
Phone	731 352-7907
CertificateType	4
CertificateEffectiveDate	2/16/2024
CertificateExpirationDate	2/15/2026
FacilityType	Waiver

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