10D0275247 CLIA NUMBER - FLORIDA PRIMARY CARE CENTER PA

Laboratory Demographics

CLIA Number: 10D0275247

Facility Name: FLORIDA PRIMARY CARE CENTER PA

Facility Address:
15493 STONEYBROOK W PKWY STE 110
WINTER GARDEN, FL
ZIP 34787
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Facility Phone Number: 407 299-7791

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1609197920

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D0275247
LAB Type	Physician Office
Facility Name	FLORIDA PRIMARY CARE CENTER PA
Street	15493 STONEYBROOK W PKWY STE 110
City	WINTER GARDEN
State	FL
ZIP	34787
Phone	407 299-7791
CertificateType	4
CertificateEffectiveDate	10/16/2023
CertificateExpirationDate	10/15/2025
FacilityType	Waiver

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