44D2191491 CLIA NUMBER - HMG ENT KINGSPORT

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Laboratory Demographics

CLIA Number: 44D2191491

Facility Name: HMG ENT KINGSPORT

Facility Address:
5 SHERIDAN SQUARE
KINGSPORT, TN
ZIP 37660
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Facility Phone Number: 423 246-8155

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1629536826

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	44D2191491
LAB Type	Physician Office
Facility Name	HMG ENT KINGSPORT
Street	5 SHERIDAN SQUARE
City	KINGSPORT
State	TN
ZIP	37660
Phone	423 246-8155
CertificateType	4
CertificateEffectiveDate	8/27/2022
CertificateExpirationDate	8/26/2024
FacilityType	Waiver

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