44D2170815 CLIA NUMBER - MOSCOW FAMILY MEDICAL LLC

Laboratory Demographics

CLIA Number: 44D2170815

Facility Name: MOSCOW FAMILY MEDICAL LLC

Facility Address:
13775 HIGHWAY 57 SUITE 4
MOSCOW, TN
ZIP 38057
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Facility Phone Number: 901 877-3070

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1548828304

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	44D2170815
LAB Type	Practitioner Other
Facility Name	MOSCOW FAMILY MEDICAL LLC
Street	13775 HIGHWAY 57 SUITE 4
City	MOSCOW
State	TN
ZIP	38057
Phone	901 877-3070
CertificateType	4
CertificateEffectiveDate	8/20/2023
CertificateExpirationDate	8/19/2025
FacilityType	Waiver

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