44D2083825 CLIA NUMBER - VIP PRIMARY CARE LLC

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Laboratory Demographics

CLIA Number: 44D2083825

Facility Name: VIP PRIMARY CARE LLC

Facility Address:
933 EAST TRI COUNTY BLVD
OLIVER SPRINGS, TN
ZIP 37840
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Facility Phone Number: 865 314-0092

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1124791975

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	44D2083825
LAB Type	Practitioner Other
Facility Name	VIP PRIMARY CARE LLC
Street	933 EAST TRI COUNTY BLVD
City	OLIVER SPRINGS
State	TN
ZIP	37840
Phone	865 314-0092
CertificateType	4
CertificateEffectiveDate	9/12/2022
CertificateExpirationDate	9/11/2024
FacilityType	Waiver

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