44D2030457 CLIA NUMBER - CLINCHFIELD FAMILY MEDICINE

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Laboratory Demographics

CLIA Number: 44D2030457

Facility Name: CLINCHFIELD FAMILY MEDICINE

Facility Address:
1936 BROOKSIDE DRIVE, SUITE E
KINGSPORT, TN
ZIP 37660
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Facility Phone Number: 423 378-1500

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1316228075

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	44D2030457
LAB Type	Physician Office
Facility Name	CLINCHFIELD FAMILY MEDICINE
Street	1936 BROOKSIDE DRIVE, SUITE E
City	KINGSPORT
State	TN
ZIP	37660
Phone	423 378-1500
CertificateType	4
CertificateEffectiveDate	9/28/2023
CertificateExpirationDate	9/27/2025
FacilityType	Waiver

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