01D2116647 CLIA NUMBER - MOULTON PRIMARY CARE CLINIC

Laboratory Demographics

CLIA Number: 01D2116647

Facility Name: MOULTON PRIMARY CARE CLINIC

Facility Address:
40 MEDICAL CIRCLE
MOULTON, AL
ZIP 35650
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Facility Phone Number: 256 974-2225

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1760930200

Taxonomy: 261QR1300X - Clinic/Center

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
CertificateType	4
CertificateEffectiveDate	7/29/2022
CertificateExpirationDate	7/28/2024
FacilityType	Waiver

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