01D0304775 CLIA NUMBER - WIREGRASS CLINIC LLC

Laboratory Demographics

  • CLIA Code: 01D0304775
  • Facility Name: WIREGRASS CLINIC LLC
  • Facility Address: 210 WESTSIDE DR
    DOTHAN, AL
    ZIP 36303
  • Facility Phone: 334 794-5074
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RUSSELL L. BEDSOLE
  • NPI Number: 1922500198
  • Taxonomy: 261QD0000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 01D0304775
LAB Type Physician Office
Facility Name WIREGRASS CLINIC LLC
Street 210 WESTSIDE DR
City DOTHAN
State AL
ZIP 36303
Phone 334 794-5074
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/2/2025
Certificate Expiration Date 1/1/2027
Facility Type Physician Office
Lab Director RUSSELL L. BEDSOLE

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This page was last updated on: 9/29/2025