01D0692392 CLIA NUMBER - MOSTELLAR MEDICAL CENTER

Laboratory Demographics

CLIA Number: 01D0692392

Facility Name: MOSTELLAR MEDICAL CENTER

Facility Address:
12701 PADGETT SWITCH RD
IRVINGTON, AL
ZIP 36544
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Facility Phone Number: 251 824-2174

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1396794426

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name Field Value
CLIA Number 01D0692392
LAB Type Federally Qualified Health Center
Facility Name MOSTELLAR MEDICAL CENTER
Street 12701 PADGETT SWITCH RD
City IRVINGTON
State AL
ZIP 36544
Phone 251 824-2174
CertificateType 4
CertificateEffectiveDate 1/3/2023
CertificateExpirationDate 1/2/2025
FacilityType Waiver

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