01D0304803 CLIA NUMBER - SOUTHEAST CARDIOLOGY CLINIC INC

Laboratory Demographics

  • Code: 01D0304803
  • Facility Name: SOUTHEAST CARDIOLOGY CLINIC INC
  • Facility Address: 1146 ROSS CLARK CIRCLE SE
    DOTHAN, AL
    ZIP 36301
  • Facility Phone: 334 712-1929
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • NPI Number: 1285790915
  • Taxonomy: 207RC0000X - Internal Medicine
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CLIA Record

Field Name Field Value
CLIA Number 01D0304803
LAB Type Physician Office
Facility Name SOUTHEAST CARDIOLOGY CLINIC INC
Street 1146 ROSS CLARK CIRCLE SE
City DOTHAN
State AL
ZIP 36301
Phone 334 712-1929
Certificate Type 4
Certificate Effective Date 12/23/2023
Certificate Expiration Date 12/22/2025
Facility Type Waiver

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