10D0856905 CLIA NUMBER - SACRED HEART MEDICAL GROUP

Laboratory Demographics

CLIA Number: 10D0856905

Facility Name: SACRED HEART MEDICAL GROUP

Facility Address:
2156 W NINE MILE RD STE C
PENSACOLA, FL
ZIP 32534
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Facility Phone Number: 850 478-2333

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1881134153

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	10D0856905
LAB Type	Physician Office
Facility Name	SACRED HEART MEDICAL GROUP
Street	2156 W NINE MILE RD STE C
City	PENSACOLA
State	FL
ZIP	32534
Phone	850 478-2333
CertificateType	4
CertificateEffectiveDate	6/11/2022
CertificateExpirationDate	6/10/2024
FacilityType	Waiver

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