01D2300083 CLIA NUMBER - PEDIATRIC CLINIC, LLC-CHAMPIONS LOCATION

Laboratory Demographics

  • CLIA Code: 01D2300083
  • Facility Name: PEDIATRIC CLINIC, LLC-CHAMPIONS LOCATION
  • Facility Address: 2375 CHAMPIONS BLVD, SUITE 3
    AUBURN, AL
    ZIP 36830
  • Facility Phone: 334 749-8121
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. RICHARD L. GLAZE
  • NPI Number: 1134286248
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 01D2300083
LAB Type Physician Office
Facility Name PEDIATRIC CLINIC, LLC-CHAMPIONS LOCATION
Street 2375 CHAMPIONS BLVD, SUITE 3
City AUBURN
State AL
ZIP 36830
Phone 334 749-8121
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/4/2024
Certificate Expiration Date 3/3/2026
Facility Type Physician Office
Lab Director DR. RICHARD L. GLAZE

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