44D0981759 CLIA NUMBER - BONK INTERNAL MEDICINE INC AMY BONK CHANIN MSPAC

Laboratory Demographics

CLIA Number: 44D0981759

Facility Name: BONK INTERNAL MEDICINE INC AMY BONK CHANIN MSPAC

Facility Address:
5565 MURRAY AVE SUITE 200
MEMPHIS, TN
ZIP 38119
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Facility Phone Number: 901 761-1850

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1972920452

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	44D0981759
LAB Type	Physician Office
Facility Name	BONK INTERNAL MEDICINE INC AMY BONK CHANIN MSPAC
Street	5565 MURRAY AVE SUITE 200
City	MEMPHIS
State	TN
ZIP	38119
Phone	901 761-1850
CertificateType	4
CertificateEffectiveDate	1/4/2023
CertificateExpirationDate	1/3/2025
FacilityType	Waiver

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