10D0718243 CLIA NUMBER - BELLAM MEDICAL CLINIC

Laboratory Demographics

CLIA Number: 10D0718243

Facility Name: BELLAM MEDICAL CLINIC

Facility Address:
20021 SW 111TH PL
DUNNELLON, FL
ZIP 34432
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Facility Phone Number: 352 465-1199

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1154475200

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D0718243
LAB Type	Physician Office
Facility Name	BELLAM MEDICAL CLINIC
Street	20021 SW 111TH PL
City	DUNNELLON
State	FL
ZIP	34432
Phone	352 465-1199
CertificateType	4
CertificateEffectiveDate	4/10/2023
CertificateExpirationDate	4/9/2025
FacilityType	Waiver

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