44D2217765 CLIA NUMBER - OMNI COMMUNITY HEALTH - GOODLETTSVILLE

Laboratory Demographics

CLIA Number: 44D2217765

Facility Name: OMNI COMMUNITY HEALTH - GOODLETTSVILLE

Facility Address:
740 CONFERENCE DRIVE
GOODLETTSVILLE, TN
ZIP 37072
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Facility Phone Number: 615 992-9082

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1316573199

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	44D2217765
LAB Type	Physician Office
Facility Name	OMNI COMMUNITY HEALTH - GOODLETTSVILLE
Street	740 CONFERENCE DRIVE
City	GOODLETTSVILLE
State	TN
ZIP	37072
Phone	615 992-9082
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