10D0291323 CLIA NUMBER - TAMPA INTERNIST PA

Laboratory Demographics

CLIA Number: 10D0291323

Facility Name: TAMPA INTERNIST PA

Facility Address:
4543 S MANHATTAN AVE SUITE 103
TAMPA, FL
ZIP 33611
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Facility Phone Number: 813 831-8888

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1497866560

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D0291323
LAB Type	Physician Office
Facility Name	TAMPA INTERNIST PA
Street	4543 S MANHATTAN AVE SUITE 103
City	TAMPA
State	FL
ZIP	33611
Phone	813 831-8888
CertificateType	4
CertificateEffectiveDate	6/17/2022
CertificateExpirationDate	6/16/2024
FacilityType	Waiver

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