01D0301960 CLIA NUMBER - PICKENS COUNTY PRIMARY CARE PC

Laboratory Demographics

  • Code: 01D0301960
  • Facility Name: PICKENS COUNTY PRIMARY CARE PC
  • Facility Address: 108 4TH AVENUE SW, SUITE A
    REFORM, AL
    ZIP 35481
  • Facility Phone: 205 375-6251
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • NPI Number: 1104183334
  • Taxonomy: 261QP2300X - Clinic/Center
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CLIA Record

Field Name Field Value
CLIA Number 01D0301960
LAB Type Physician Office
Facility Name PICKENS COUNTY PRIMARY CARE PC
Street 108 4TH AVENUE SW, SUITE A
City REFORM
State AL
ZIP 35481
Phone 205 375-6251
Certificate Type 4
Certificate Effective Date 3/24/2023
Certificate Expiration Date 3/23/2025
Facility Type Waiver

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