44D2133307 CLIA NUMBER - FAMILY CLINIC AT THE LAKE PLLC

Laboratory Demographics

CLIA Number: 44D2133307

Facility Name: FAMILY CLINIC AT THE LAKE PLLC

Facility Address:
11268 HWY 57
COUNCE, TN
ZIP 38326
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Facility Phone Number: 731 689-4357

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1578125647

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	44D2133307
LAB Type	Rural Health Clinic
Facility Name	FAMILY CLINIC AT THE LAKE PLLC
Street	11268 HWY 57
City	COUNCE
State	TN
ZIP	38326
Phone	731 689-4357
CertificateType	4
CertificateEffectiveDate	7/10/2023
CertificateExpirationDate	7/9/2025
FacilityType	Waiver

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