01D0857036 CLIA NUMBER - VALLEY HEAD CLINIC/DBA PISGAH MED CLINIC PISGAH MEDICAL CLINIC

Laboratory Demographics

CLIA Number: 01D0857036

Facility Name: VALLEY HEAD CLINIC/DBA PISGAH MED CLINIC PISGAH MEDICAL CLINIC

Facility Address:
6110 COUNTY ROAD 88
PISGAH, AL
ZIP 35765
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Facility Phone Number: 256 451-1250

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1679827497

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	01D0857036
LAB Type	Physician Office
Facility Name	VALLEY HEAD CLINIC/DBA PISGAH MED CLINIC PISGAH MEDICAL CLINIC
Street	6110 COUNTY ROAD 88
City	PISGAH
State	AL
ZIP	35765
Phone	256 451-1250
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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