10D0289295 CLIA NUMBER - PHYSICIAN CARE WALK-IN CLINIC

Laboratory Demographics

CLIA Number: 10D0289295

Facility Name: PHYSICIAN CARE WALK-IN CLINIC

Facility Address:
620 VONDERBURG DR
BRANDON, FL
ZIP 33511
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Facility Phone Number: 813 684-1777

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1699710467

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	10D0289295
LAB Type	Physician Office
Facility Name	PHYSICIAN CARE WALK-IN CLINIC
Street	620 VONDERBURG DR
City	BRANDON
State	FL
ZIP	33511
Phone	813 684-1777
CertificateType	4
CertificateEffectiveDate	9/30/2023
CertificateExpirationDate	9/29/2025
FacilityType	Waiver

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