10D0676224 CLIA NUMBER - BAPTIST PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 10D0676224
  • Facility Name: BAPTIST PRIMARY CARE
  • Facility Address: 9090 REGENCY SQUARE BLVD N
    JACKSONVILLE, FL
    ZIP 32211
  • Facility Phone: 904 724-5576
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MANUEL PORTALATIN
  • NPI Number: 1891976734
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D0676224
LAB Type Physician Office
Facility Name BAPTIST PRIMARY CARE
Street 9090 REGENCY SQUARE BLVD N
City JACKSONVILLE
State FL
ZIP 32211
Phone 904 724-5576
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/24/2024
Certificate Expiration Date 6/23/2026
Facility Type Physician Office
Lab Director MANUEL PORTALATIN

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This page was last updated on: 9/29/2025