44D2186778 CLIA NUMBER - BROADWAY AND MAIN

Laboratory Demographics

  • CLIA Code: 44D2186778
  • Facility Name: BROADWAY AND MAIN
  • Facility Address: 136 E BROADWAY
    NEWPORT, TN
    ZIP 37821
  • Facility Phone: 423 720-9777
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JARROD S. VICK
  • NPI Number: 1073086807
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 44D2186778
LAB Type Pharmacy
Facility Name BROADWAY AND MAIN
Street 136 E BROADWAY
City NEWPORT
State TN
ZIP 37821
Phone 423 720-9777
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/22/2024
Certificate Expiration Date 6/21/2026
Facility Type Pharmacy
Lab Director JARROD S. VICK

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