44D2119757 CLIA NUMBER - PREMISE HEALTH OF TENNESSEE MEDICAL, PC

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Laboratory Demographics

CLIA Number: 44D2119757

Facility Name: PREMISE HEALTH OF TENNESSEE MEDICAL, PC

Facility Address:
501 NORTH CHEROKEE ST SUITE 3
JONESBOROUGH, TN
ZIP 37659
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Facility Phone Number: 423 597-6079

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1720651987

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	44D2119757
LAB Type	Physician Office
Facility Name	PREMISE HEALTH OF TENNESSEE MEDICAL, PC
Street	501 NORTH CHEROKEE ST SUITE 3
City	JONESBOROUGH
State	TN
ZIP	37659
Phone	423 597-6079
CertificateType	4
CertificateEffectiveDate	10/4/2022
CertificateExpirationDate	10/3/2024
FacilityType	Waiver

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