01D2116647 CLIA NUMBER - MOULTON PRIMARY CARE CLINIC

Laboratory Demographics

  • CLIA Code: 01D2116647
  • Facility Name: MOULTON PRIMARY CARE CLINIC
  • Facility Address: 40 MEDICAL CIRCLE
    MOULTON, AL
    ZIP 35650
  • Facility Phone: 256 974-2225
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: SAMUEL N. GILLESPIE
  • NPI Number: 1760930200
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 01D2116647
LAB Type Rural Health Clinic
Facility Name MOULTON PRIMARY CARE CLINIC
Street 40 MEDICAL CIRCLE
City MOULTON
State AL
ZIP 35650
Phone 256 974-2225
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/29/2024
Certificate Expiration Date 7/28/2026
Facility Type Rural Health Clinic
Lab Director SAMUEL N. GILLESPIE

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