01D0697315 CLIA NUMBER - PREMISE HEALTH OF ALABAMA MEDICAL , PC

Laboratory Demographics

CLIA Number: 01D0697315

Facility Name: PREMISE HEALTH OF ALABAMA MEDICAL , PC

Facility Address:
200 WAITS DRIVE
ANDALUSIA, AL
ZIP 36421
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Facility Phone Number: (334) 427-6699

Facility Type: PHYSICIAN OFFICE

Certificate Type: Waiver

NPI Number: 1508470899

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	01D0697315
LAB Type	PHYSICIAN OFFICE
Facility Name	PREMISE HEALTH OF ALABAMA MEDICAL , PC
Street	200 WAITS DRIVE
City	ANDALUSIA
State	AL
ZIP	36421
Phone	(334) 427-6699

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This page was last updated on: 5/11/2023