10D0695532 CLIA NUMBER - CHILDRENS MEDICAL CENTER

Laboratory Demographics

  • CLIA Code: 10D0695532
  • Facility Name: CHILDRENS MEDICAL CENTER
  • Facility Address: 1002 SW 11TH ST
    LIVE OAK, FL
    ZIP 32064
  • Facility Phone: 904 364-8050
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ANDRES R. VILLAR
  • NPI Number: 1295829398
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D0695532
LAB Type Physician Office
Facility Name CHILDRENS MEDICAL CENTER
Street 1002 SW 11TH ST
City LIVE OAK
State FL
ZIP 32064
Phone 904 364-8050
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/26/2024
Certificate Expiration Date 7/25/2026
Facility Type Physician Office
Lab Director ANDRES R. VILLAR

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