01D2085824 CLIA NUMBER - DBA GRANDVIEW PRIMARY CARE HELENA AFFINITY PHYSICIANS

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Laboratory Demographics

CLIA Number: 01D2085824

Facility Name: DBA GRANDVIEW PRIMARY CARE HELENA AFFINITY PHYSICIANS

Facility Address:
2256 - C HELENA ROAD
HELENA, AL
ZIP 35080
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Facility Phone Number: 205 971-1840

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1154725265

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	01D2085824
LAB Type	Physician Office
Facility Name	DBA GRANDVIEW PRIMARY CARE HELENA AFFINITY PHYSICIANS
Street	2256 - C HELENA ROAD
City	HELENA
State	AL
ZIP	35080
Phone	205 971-1840
CertificateType	4
CertificateEffectiveDate	11/2/2023
CertificateExpirationDate	11/1/2025
FacilityType	Waiver

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