44D0873186 CLIA NUMBER - EAST TENNESSEE STATE UNIVERSITY DBA EAST TN STATE UNIVERSITY JOHNSON CITY COMMUNITY HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 44D0873186
  • Facility Name: EAST TENNESSEE STATE UNIVERSITY DBA EAST TN STATE UNIVERSITY JOHNSON CITY COMMUNITY HEALTH CENTER
  • Facility Address: 2151 CENTURY LANE
    JOHNSON CITY, TN
    ZIP 37604
  • Facility Phone: 423 929-6932
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Microscopy
  • Lab Director: AMANDA MOORHOUSE
  • NPI Number: 1689056624
  • Taxonomy: 1223G0001X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 44D0873186
LAB Type Federally Qualified Health Center
Facility Name EAST TENNESSEE STATE UNIVERSITY DBA EAST TN STATE UNIVERSITY JOHNSON CITY COMMUNITY HEALTH CENTER
Street 2151 CENTURY LANE
City JOHNSON CITY
State TN
ZIP 37604
Phone 423 929-6932
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 4/19/2025
Certificate Expiration Date 4/18/2027
Facility Type Federally Qualified Health Center
Lab Director AMANDA MOORHOUSE

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