01D2045697 CLIA NUMBER - CRESTWOOD FAMILY PRACTICE - WHITESPORT CIRCLE

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Laboratory Demographics

CLIA Number: 01D2045697

Facility Name: CRESTWOOD FAMILY PRACTICE - WHITESPORT CIRCLE

Facility Address:
165 WHITESPORT DRIVE SUITE 1
HUNTSVILLE, AL
ZIP 35801
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Facility Phone Number: 256 880-0450

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1154622520

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	01D2045697
LAB Type	Physician Office
Facility Name	CRESTWOOD FAMILY PRACTICE - WHITESPORT CIRCLE
Street	165 WHITESPORT DRIVE SUITE 1
City	HUNTSVILLE
State	AL
ZIP	35801
Phone	256 880-0450
CertificateType	4
CertificateEffectiveDate	8/17/2022
CertificateExpirationDate	8/16/2024
FacilityType	Waiver

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