44D1057640 CLIA NUMBER - CROSSROADS MEDICAL GROUP PLLC

Laboratory Demographics

  • CLIA Code: 44D1057640
  • Facility Name: CROSSROADS MEDICAL GROUP PLLC
  • Facility Address: 420 HIGHWAY 52 W
    PORTLAND, TN
    ZIP 37148
  • Facility Phone: 615 325-2226
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SCOTT JORDAN
  • NPI Number: 1578823506
  • Taxonomy: 363L00000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 44D1057640
LAB Type Physician Office
Facility Name CROSSROADS MEDICAL GROUP PLLC
Street 420 HIGHWAY 52 W
City PORTLAND
State TN
ZIP 37148
Phone 615 325-2226
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/17/2024
Certificate Expiration Date 8/16/2026
Facility Type Physician Office
Lab Director SCOTT JORDAN

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