44D0860533 CLIA NUMBER - EAST TENNESSEE STATE UNIVERSITY DBA EAST TENNESSEE STATE UNIVERSITY MOUNTAIN CITY

Laboratory Demographics

CLIA Number: 44D0860533

Facility Name: EAST TENNESSEE STATE UNIVERSITY DBA EAST TENNESSEE STATE UNIVERSITY MOUNTAIN CITY

Facility Address:
1901 SOUTH SHADY STREET
MOUNTAIN CITY, TN
ZIP 37683
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Facility Phone Number: 423 727-1150

Facility Type: Rural Health Clinic

Certificate Type: Microscopy

NPI Number: 1083832117

Taxonomy: 320600000X - Residential Treatment Facility, Intellectual and/or Developmental Disabilities
A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.

CLIA Record

Field Name	Field Value
CLIA Number	44D0860533
LAB Type	Rural Health Clinic
Facility Name	EAST TENNESSEE STATE UNIVERSITY DBA EAST TENNESSEE STATE UNIVERSITY MOUNTAIN CITY
Street	1901 SOUTH SHADY STREET
City	MOUNTAIN CITY
State	TN
ZIP	37683
Phone	423 727-1150
CertificateType	3
CertificateEffectiveDate	8/29/2022
CertificateExpirationDate	8/28/2024
FacilityType	PPMP

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