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General NPI Number Information
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NPI Number | 1871177329
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Entity Type | Organization
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Legal Business Name | CLUTCH DIAGNOSTICS, LLC
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Dates
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Enumeration Date | 05/11/2021
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Last Update Date | 07/30/2024
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Provider Practice Location Address
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Address Line | 320 COMMERCE ST
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City | CHILDRESS
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State | TX
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Zip | 79201-4526
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Country | US
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Telephone | 844-429-4279
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Fax | 888-918-0496
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Provider Business Mailing Address
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Address Line | 320 COMMERCE ST
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City | CHILDRESS
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State | TX
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Zip | 79201-4526
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Country | US
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Telephone | 844-429-4279
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Fax | 888-918-0496
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Authorized Official
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Title or Position | CEO
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Name | MR. REUBEN BUCKAREFF
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Credential |
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Telephone | 404-313-8830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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