01D2123018 CLIA NUMBER - LAKE EUFAULA PRIMARY CARE

Laboratory Demographics

CLIA Number: 01D2123018

Facility Name: LAKE EUFAULA PRIMARY CARE

Facility Address:
130B NORTH RANDOLPH AVENUE
EUFAULA, AL
ZIP 36027
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Facility Phone Number: 334 688-7451

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1083164099

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	01D2123018
LAB Type	Physician Office
Facility Name	LAKE EUFAULA PRIMARY CARE
Street	130B NORTH RANDOLPH AVENUE
City	EUFAULA
State	AL
ZIP	36027
Phone	334 688-7451
CertificateType	4
CertificateEffectiveDate	12/12/2022
CertificateExpirationDate	12/11/2024
FacilityType	Waiver

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