10D0723706 CLIA NUMBER - CONVIVA MEDICAL CENTER MANAGEMENT LLC DBA CONVIVA SENIOR PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 10D0723706
  • Facility Name: CONVIVA MEDICAL CENTER MANAGEMENT LLC DBA CONVIVA SENIOR PRIMARY CARE
  • Facility Address: 514 SE PORT ST LUCIE BLVD
    PORT SAINT LUCIE, FL
    ZIP 34984
  • Facility Phone: 772 871-5900
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ASHLEY M. DEBAY
  • NPI Number: 1861535726
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D0723706
LAB Type Physician Office
Facility Name CONVIVA MEDICAL CENTER MANAGEMENT LLC DBA CONVIVA SENIOR PRIMARY CARE
Street 514 SE PORT ST LUCIE BLVD
City PORT SAINT LUCIE
State FL
ZIP 34984
Phone 772 871-5900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/18/2024
Certificate Expiration Date 7/17/2026
Facility Type Physician Office
Lab Director ASHLEY M. DEBAY

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