44D2204208 CLIA NUMBER - EMERGENCE OF COFFEE COUNTY

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Laboratory Demographics

CLIA Number: 44D2204208

Facility Name: EMERGENCE OF COFFEE COUNTY

Facility Address:
108 EAST LAUDERDALE STREET
TULLAHOMA, TN
ZIP 37388
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Facility Phone Number: 931 222-4670

Facility Type: Other - OFFICE OPIOD TREATMENT

Certificate Type: Waiver

NPI Number: 1124505540

Taxonomy: 261QR0800X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	44D2204208
LAB Type	Other - OFFICE OPIOD TREATMENT
Facility Name	EMERGENCE OF COFFEE COUNTY
Street	108 EAST LAUDERDALE STREET
City	TULLAHOMA
State	TN
ZIP	37388
Phone	931 222-4670
CertificateType	4
CertificateEffectiveDate	12/8/2022
CertificateExpirationDate	12/7/2024
FacilityType	Waiver

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