10D0273769 CLIA NUMBER - BOLICK CLINIC THE

Laboratory Demographics

  • CLIA Code: 10D0273769
  • Facility Name: BOLICK CLINIC THE
  • Facility Address: 500 E HORATIO AVENUE
    MAITLAND, FL
    ZIP 32751
  • Facility Phone: 407 629-5333
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHANNING C. BOLICK
  • NPI Number: 1073680088
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D0273769
LAB Type Physician Office
Facility Name BOLICK CLINIC THE
Street 500 E HORATIO AVENUE
City MAITLAND
State FL
ZIP 32751
Phone 407 629-5333
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director CHANNING C. BOLICK

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