44D0964457 CLIA NUMBER - EAST TENNESSEE AMBULATORY SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 44D0964457
  • Facility Name: EAST TENNESSEE AMBULATORY SURGERY CENTER
  • Facility Address: 701 MED-TECH PARKWAY SUITE 100
    JOHNSON CITY, TN
    ZIP 37604
  • Facility Phone: 423 610-3602
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: JIM N. BRANTNER
  • NPI Number: 1235300179
  • Taxonomy: 207RH0003X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 44D0964457
LAB Type Ambulatory Surgery Center
Facility Name EAST TENNESSEE AMBULATORY SURGERY CENTER
Street 701 MED-TECH PARKWAY SUITE 100
City JOHNSON CITY
State TN
ZIP 37604
Phone 423 610-3602
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/26/2025
Certificate Expiration Date 8/25/2027
Facility Type Ambulatory Surgery Center
Lab Director JIM N. BRANTNER

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