10D0274460 CLIA NUMBER - NORTH BREVARD MEDICAL SUPPORT INC DBA PARRISH MEDICAL GROUP

Laboratory Demographics

CLIA Number: 10D0274460

Facility Name: NORTH BREVARD MEDICAL SUPPORT INC DBA PARRISH MEDICAL GROUP

Facility Address:
250 HARRISON STREET
TITUSVILLE, FL
ZIP 32780
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Facility Phone Number: 321 267-1426

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1689060873

Taxonomy: 251V00000X - Voluntary or Charitable

CLIA Record

Field Name	Field Value
CLIA Number	10D0274460
LAB Type	Physician Office
Facility Name	NORTH BREVARD MEDICAL SUPPORT INC DBA PARRISH MEDICAL GROUP
Street	250 HARRISON STREET
City	TITUSVILLE
State	FL
ZIP	32780
Phone	321 267-1426
CertificateType	4
CertificateEffectiveDate	8/24/2022
CertificateExpirationDate	8/23/2024
FacilityType	Waiver

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