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44D2188743 CLIA NUMBER - PREMISE HEALTH OF TENNESSEE MEDICAL, PC

Laboratory Demographics

CLIA Number: 44D2188743

Facility Name: PREMISE HEALTH OF TENNESSEE MEDICAL, PC

Facility Address:
262 DANNY THOMAS PLACE
MEMPHIS, TN
ZIP 38105
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Facility Phone Number: 901 595-9355

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1144851858

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name Field Value
CLIA Number 44D2188743
LAB Type Physician Office
Facility Name PREMISE HEALTH OF TENNESSEE MEDICAL, PC
Street 262 DANNY THOMAS PLACE
City MEMPHIS
State TN
ZIP 38105
Phone 901 595-9355
CertificateType 4
CertificateEffectiveDate 7/21/2022
CertificateExpirationDate 7/20/2024
FacilityType Waiver

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