10D0724739 CLIA NUMBER - NORTHWEST FLORIDA COMMUNITY HOSPITAL DBA CHIPLEY MEDICAL GROUP

Laboratory Demographics

CLIA Number: 10D0724739

Facility Name: NORTHWEST FLORIDA COMMUNITY HOSPITAL DBA CHIPLEY MEDICAL GROUP

Facility Address:
1376 BRICKYARD RD
CHIPLEY, FL
ZIP 32428
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Facility Phone Number: 850 638-0552

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1740644202

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D0724739
LAB Type	Rural Health Clinic
Facility Name	NORTHWEST FLORIDA COMMUNITY HOSPITAL DBA CHIPLEY MEDICAL GROUP
Street	1376 BRICKYARD RD
City	CHIPLEY
State	FL
ZIP	32428
Phone	850 638-0552
CertificateType	4
CertificateEffectiveDate	3/4/2024
CertificateExpirationDate	3/3/2026
FacilityType	Waiver

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