01D2316620 CLIA NUMBER - SOUTHSIDE PEDIATRICS LLC

Laboratory Demographics

  • CLIA Code: 01D2316620
  • Facility Name: SOUTHSIDE PEDIATRICS LLC
  • Facility Address: 1322 HIGHWAY 77
    SOUTHSIDE, AL
    ZIP 35907
  • Facility Phone: 256 344-7070
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL HALLENBECK
  • NPI Number: 1215759246
  • Taxonomy: 208000000X - Pediatrics

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 01D2316620
LAB Type Physician Office
Facility Name SOUTHSIDE PEDIATRICS LLC
Street 1322 HIGHWAY 77
City SOUTHSIDE
State AL
ZIP 35907
Phone 256 344-7070
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/9/2025
Certificate Expiration Date 1/8/2027
Facility Type Physician Office
Lab Director MICHAEL HALLENBECK

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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