10D0267042 CLIA NUMBER - ANDREW C BASS MD

Laboratory Demographics

CLIA Number: 10D0267042

Facility Name: ANDREW C BASS MD

Facility Address:
315 SOUTH SCRIVEN AVENUE
LIVE OAK, FL
ZIP 32064
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Facility Phone Number: 386 362-4822

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1912978693

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	10D0267042
LAB Type	Physician Office
Facility Name	ANDREW C BASS MD
Street	315 SOUTH SCRIVEN AVENUE
City	LIVE OAK
State	FL
ZIP	32064
Phone	386 362-4822
CertificateType	4
CertificateEffectiveDate	11/2/2022
CertificateExpirationDate	11/1/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024