Provider Demographics
NPI:1871177329
Name:CLUTCH DIAGNOSTICS, LLC
Entity type:Organization
Organization Name:CLUTCH DIAGNOSTICS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:REUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKAREFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-313-8830
Mailing Address - Street 1:320 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:CHILDRESS
Mailing Address - State:TX
Mailing Address - Zip Code:79201-4526
Mailing Address - Country:US
Mailing Address - Phone:844-429-4279
Mailing Address - Fax:888-918-0496
Practice Address - Street 1:320 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:CHILDRESS
Practice Address - State:TX
Practice Address - Zip Code:79201-4526
Practice Address - Country:US
Practice Address - Phone:844-429-4279
Practice Address - Fax:888-918-0496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11D2190362OtherCLIA