DIABETES AND WELLNESS CLINIC OF THE SHOALS NPI 1255892865

Clinic/Center in Muscle Shoals, AL

NPI 1255892865 Organization Clinic/Center CLIA Number 01D2165657 CLIA Certificate of Waiver

About DIABETES AND WELLNESS CLINIC OF THE SHOALS

Diabetes And Wellness Clinic Of The Shoals is a provider established in Muscle Shoals, Alabama specializing in clinic/center. The NPI number of Diabetes And Wellness Clinic Of The Shoals is 1255892865 and was assigned on March 2019. The practitioner's primary taxonomy code is 261Q00000X. The provider is registered as an organization and their NPI record was last updated 3 years ago. The authorized official of this NPI record is Thaddeus Jason Boughton Crnp (Owner)

The CLIA number of Diabetes And Wellness Clinic Of The Shoals is 01D2165657 registered as a "other" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to Diabetes And Wellness Clinic Of The Shoals to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI

1255892865

Provider NameDIABETES AND WELLNESS CLINIC OF THE SHOALS
Provider Location Address1110 E 6TH ST SUITE E MUSCLE SHOALS, AL 35661
Provider Mailing Address114 CHAPPELL RD MUSCLE SHOALS, AL 35661
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date03-27-2019
Last Update Date03-27-2019


Primary Taxonomy

Taxonomy Code261Q00000X
ClassificationClinic/Center
TypeAmbulatory Health Care Facilities
Taxonomy DescriptionA facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

Business Address

DIABETES AND WELLNESS CLINIC OF THE SHOALS
1110 E 6TH ST SUITE E
MUSCLE SHOALS, AL
ZIP 35661
Phone: (256) 856-4059

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Mailing Address

DIABETES AND WELLNESS CLINIC OF THE SHOALS
114 CHAPPELL RD
MUSCLE SHOALS, AL
ZIP 35661
Phone:



Authorized Official

Authorized Official Name THADDEUS JASON BOUGHTON CRNP
Authorized Official TitleOWNER
Authorized Official Phone(256) 856-4059

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1255892865 is:

CLIA Number01D2165657
Facility TypeOTHER
Certificate TypeCertificate of Waiver

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.