01D2055996 CLIA NUMBER - PREMIER MEDICAL CLINIC LLC

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Laboratory Demographics

CLIA Number: 01D2055996

Facility Name: PREMIER MEDICAL CLINIC LLC

Facility Address:
506 HARLEY STREET
SCOTTSBORO, AL
ZIP 35768
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Facility Phone Number: 256 259-1886

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1083955173

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	01D2055996
LAB Type	Physician Office
Facility Name	PREMIER MEDICAL CLINIC LLC
Street	506 HARLEY STREET
City	SCOTTSBORO
State	AL
ZIP	35768
Phone	256 259-1886
CertificateType	4
CertificateEffectiveDate	3/20/2023
CertificateExpirationDate	3/19/2025
FacilityType	Waiver

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