44D2120862 CLIA NUMBER - VICTORY TREATMENT PROGRAM, LLC DBA MALTMAN MEDICAL CENTER

Laboratory Demographics

  • CLIA Code: 44D2120862
  • Facility Name: VICTORY TREATMENT PROGRAM, LLC DBA MALTMAN MEDICAL CENTER
  • Facility Address: 9051 EXECUTIVE PARK DR STE 202
    KNOXVILLE, TN
    ZIP 37923
  • Facility Phone: 865 337-7812
  • Facility Type: Practitioner Other
  • Facility Type: Microscopy
  • Lab Director: STACEY R. MALTMAN
  • NPI Number: 1508320623
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 44D2120862
LAB Type Practitioner Other
Facility Name VICTORY TREATMENT PROGRAM, LLC DBA MALTMAN MEDICAL CENTER
Street 9051 EXECUTIVE PARK DR STE 202
City KNOXVILLE
State TN
ZIP 37923
Phone 865 337-7812
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 10/26/2024
Certificate Expiration Date 10/25/2026
Facility Type Practitioner Other
Lab Director STACEY R. MALTMAN

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