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10D0673910 CLIA NUMBER - GENESISCARE USA OF FLORIDA, LLC

Laboratory Demographics

CLIA Number: 10D0673910

Facility Name: GENESISCARE USA OF FLORIDA, LLC

Facility Address:
4571 COLONIAL BLVD, SUITE 100
FORT MYERS, FL
ZIP 33966
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Facility Phone Number: 239 931-7279

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1528442332

Taxonomy: 207YX0007X - Otolaryngology
An otolaryngologist with additional training in plastic and reconstructive procedures within the head, face, neck and associated structures, including cutaneous head and neck oncology and reconstruction, management of maxillofacial trauma, soft tissue repair and neural surgery. The field is diverse and involves a wide age range of patients, from the newborn to the aged. While both cosmetic and reconstructive surgeries are practiced, there are many additional procedures which interface with them.

CLIA Record

Field Name Field Value
CLIA Number 10D0673910
LAB Type Physician Office
Facility Name GENESISCARE USA OF FLORIDA, LLC
Street 4571 COLONIAL BLVD, SUITE 100
City FORT MYERS
State FL
ZIP 33966
Phone 239 931-7279
CertificateType 4
CertificateEffectiveDate 2/3/2023
CertificateExpirationDate 2/2/2025
FacilityType Waiver

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