44D2258618 CLIA NUMBER - VALLEY MEDICAL

Laboratory Demographics

CLIA Number: 44D2258618

Facility Name: VALLEY MEDICAL

Facility Address:
2545 JACKSBORO PIKE
JACKSBORO, TN
ZIP 37757
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Facility Phone Number: 423 352-6090

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1811631518

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	44D2258618
LAB Type	Physician Office
Facility Name	VALLEY MEDICAL
Street	2545 JACKSBORO PIKE
City	JACKSBORO
State	TN
ZIP	37757
Phone	423 352-6090
CertificateType	4
CertificateEffectiveDate	4/25/2024
CertificateExpirationDate	4/24/2026
FacilityType	Waiver

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