01D2152025 CLIA NUMBER - LAKESIDE PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 01D2152025
  • Facility Name: LAKESIDE PRIMARY CARE
  • Facility Address: 1260 CHESNUT BYPASS, SUITE A
    CENTRE, AL
    ZIP 35960
  • Facility Phone: 256 266-1544
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: AIMEE M. KILGO
  • NPI Number: 1720572407
  • Taxonomy: 363LP2300X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 01D2152025
LAB Type Practitioner Other
Facility Name LAKESIDE PRIMARY CARE
Street 1260 CHESNUT BYPASS, SUITE A
City CENTRE
State AL
ZIP 35960
Phone 256 266-1544
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/1/2024
Certificate Expiration Date 7/31/2026
Facility Type Practitioner Other
Lab Director AIMEE M. KILGO

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