10D0688318 CLIA NUMBER - MILLENNIUM PHYSICIAN GROUP

Laboratory Demographics

  • CLIA Code: 10D0688318
  • Facility Name: MILLENNIUM PHYSICIAN GROUP
  • Facility Address: 11513 N MAIN ST
    JACKSONVILLE, FL
    ZIP 32218
  • Facility Phone: 904 751-6200
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: VICTOR C. MICOLUCCI
  • NPI Number: 1720750417
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D0688318
LAB Type Physician Office
Facility Name MILLENNIUM PHYSICIAN GROUP
Street 11513 N MAIN ST
City JACKSONVILLE
State FL
ZIP 32218
Phone 904 751-6200
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 8/22/2024
Certificate Expiration Date 8/21/2026
Facility Type Physician Office
Lab Director VICTOR C. MICOLUCCI

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