01D1103536 CLIA NUMBER - PREMISE HEALTH OF ALABAMA MEDICAL, PC

Laboratory Demographics

CLIA Number: 01D1103536

Facility Name: PREMISE HEALTH OF ALABAMA MEDICAL, PC

Facility Address:
5500 CR 37
TROY, AL
ZIP 36081
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Facility Phone Number: 334 670-2122

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1376052480

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	01D1103536
LAB Type	Physician Office
Facility Name	PREMISE HEALTH OF ALABAMA MEDICAL, PC
Street	5500 CR 37
City	TROY
State	AL
ZIP	36081
Phone	334 670-2122
CertificateType	4
CertificateEffectiveDate	8/12/2023
CertificateExpirationDate	8/11/2025
FacilityType	Waiver

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