01D2207362 CLIA NUMBER - MAGNOLIA PRIMARY CARE LLC

Laboratory Demographics

  • CLIA Code: 01D2207362
  • Facility Name: MAGNOLIA PRIMARY CARE LLC
  • Facility Address: 4101 BALMORAL DRIVE SUITE B
    HUNTSVILLE, AL
    ZIP 35801
  • Facility Phone: 256 203-3949
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ROHINI RAMAMOORTHY
  • NPI Number: 1013518265
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 01D2207362
LAB Type Physician Office
Facility Name MAGNOLIA PRIMARY CARE LLC
Street 4101 BALMORAL DRIVE SUITE B
City HUNTSVILLE
State AL
ZIP 35801
Phone 256 203-3949
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/28/2024
Certificate Expiration Date 12/27/2026
Facility Type Physician Office
Lab Director ROHINI RAMAMOORTHY

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