01D1105179 CLIA NUMBER - NORTHSIDE MEDICAL INC

Laboratory Demographics

  • CLIA Code: 01D1105179
  • Facility Name: NORTHSIDE MEDICAL INC
  • Facility Address: 211 GREENHILL BLVD NW
    FORT PAYNE, AL
    ZIP 35967
  • Facility Phone: 256 845-9355
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ROBERT W. THEAKSTON
  • NPI Number: 1205089372
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 01D1105179
LAB Type Physician Office
Facility Name NORTHSIDE MEDICAL INC
Street 211 GREENHILL BLVD NW
City FORT PAYNE
State AL
ZIP 35967
Phone 256 845-9355
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/17/2025
Certificate Expiration Date 9/16/2027
Facility Type Physician Office
Lab Director ROBERT W. THEAKSTON

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This page was last updated on: 9/29/2025