44D2217763 CLIA NUMBER - OMNI COMMUNITY HEALTH - COOKEVILLE

Laboratory Demographics

CLIA Number: 44D2217763

Facility Name: OMNI COMMUNITY HEALTH - COOKEVILLE

Facility Address:
665 SOUTH JEFFERSON AVE
COOKEVILLE, TN
ZIP 38501
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Facility Phone Number: 931 528-0051

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1881743805

Taxonomy: 101YM0800X - Counselor

CLIA Record

Field Name	Field Value
CLIA Number	44D2217763
LAB Type	Physician Office
Facility Name	OMNI COMMUNITY HEALTH - COOKEVILLE
Street	665 SOUTH JEFFERSON AVE
City	COOKEVILLE
State	TN
ZIP	38501
Phone	931 528-0051
CertificateType	4
CertificateEffectiveDate	3/23/2023
CertificateExpirationDate	3/22/2025
FacilityType	Waiver

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