10D0291181 CLIA NUMBER - DWIC OF TAMPA BAY INC DBA MEDEXPRESS

Laboratory Demographics

CLIA Number: 10D0291181

Facility Name: DWIC OF TAMPA BAY INC DBA MEDEXPRESS

Facility Address:
13856 DALE MABRY HWY N
TAMPA, FL
ZIP 33618
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Facility Phone Number: 813 264-1885

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1215986344

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D0291181
LAB Type	Practitioner Other
Facility Name	DWIC OF TAMPA BAY INC DBA MEDEXPRESS
Street	13856 DALE MABRY HWY N
City	TAMPA
State	FL
ZIP	33618
Phone	813 264-1885
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