10D0290378 CLIA NUMBER - DWIC OF TAMPA BAY INC DBA MEDEXPRESS

Laboratory Demographics

CLIA Number: 10D0290378

Facility Name: DWIC OF TAMPA BAY INC DBA MEDEXPRESS

Facility Address:
2810 W DR MLK BLVD
TAMPA, FL
ZIP 33607
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Facility Phone Number: 813 877-8450

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1679522163

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D0290378
LAB Type	Practitioner Other
Facility Name	DWIC OF TAMPA BAY INC DBA MEDEXPRESS
Street	2810 W DR MLK BLVD
City	TAMPA
State	FL
ZIP	33607
Phone	813 877-8450
CertificateType	4
CertificateEffectiveDate	4/27/2022
CertificateExpirationDate	4/26/2024
FacilityType	Waiver

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