10D0269485 CLIA NUMBER - BAPTIST PRIMARY CARE MANDARIN PEDIATRICS

Laboratory Demographics

  • CLIA Code: 10D0269485
  • Facility Name: BAPTIST PRIMARY CARE MANDARIN PEDIATRICS
  • Facility Address: 14810 OLD ST AUGUSTINE RD STE 106
    JACKSONVILLE, FL
    ZIP 32258
  • Facility Phone: 904 268-7701
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: VIRGINIA BLACK
  • NPI Number: 1356677819
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 10D0269485
LAB Type Physician Office
Facility Name BAPTIST PRIMARY CARE MANDARIN PEDIATRICS
Street 14810 OLD ST AUGUSTINE RD STE 106
City JACKSONVILLE
State FL
ZIP 32258
Phone 904 268-7701
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/10/2024
Certificate Expiration Date 6/9/2026
Facility Type Physician Office
Lab Director VIRGINIA BLACK

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