01D2025230 CLIA NUMBER - RUSSELLVILLE HOSPITAL, INC DBA KEVIN G KELLY, MD

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Laboratory Demographics

CLIA Number: 01D2025230

Facility Name: RUSSELLVILLE HOSPITAL, INC DBA KEVIN G KELLY, MD

Facility Address:
11809 ALABAMA HIGHWAY 157, SUITE E
MOULTON, AL
ZIP 35650
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Facility Phone Number: 256 905-0340

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1508491093

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	01D2025230
LAB Type	Rural Health Clinic
Facility Name	RUSSELLVILLE HOSPITAL, INC DBA KEVIN G KELLY, MD
Street	11809 ALABAMA HIGHWAY 157, SUITE E
City	MOULTON
State	AL
ZIP	35650
Phone	256 905-0340
CertificateType	4
CertificateEffectiveDate	6/3/2023
CertificateExpirationDate	6/2/2025
FacilityType	Waiver

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