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01D0699520 CLIA NUMBER - BRUCE W RUSSELL MD

Laboratory Demographics

CLIA Number: 01D0699520

Facility Name: BRUCE W RUSSELL MD

Facility Address:
COMMUNITY PROFESSIONAL CTR STE 100 BRYANT ROAD
SUMITON, AL
ZIP 35148
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Facility Phone Number: (205) 648-6637

Facility Type: PHYSICIAN OFFICE

Certificate Type: Waiver

NPI Number: 1447280300

Taxonomy: 208D00000X - General Practice

CLIA Record

Field Name Field Value
CLIA Number 01D0699520
LAB Type PHYSICIAN OFFICE
Facility Name BRUCE W RUSSELL MD
Street COMMUNITY PROFESSIONAL CTR STE 100 BRYANT ROAD
City SUMITON
State AL
ZIP 35148
Phone (205) 648-6637

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This page was last updated on: 3/23/2022