10D0858610 CLIA NUMBER - PALM MEDICAL CENTER PLANTATION LLC

Laboratory Demographics

CLIA Number: 10D0858610

Facility Name: PALM MEDICAL CENTER PLANTATION LLC

Facility Address:
6971 W SUNRISE BLVD STE 106
PLANTATION, FL
ZIP 33313
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Facility Phone Number: 954 581-0040

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1417458464

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	10D0858610
LAB Type	Physician Office
Facility Name	PALM MEDICAL CENTER PLANTATION LLC
Street	6971 W SUNRISE BLVD STE 106
City	PLANTATION
State	FL
ZIP	33313
Phone	954 581-0040
CertificateType	4
CertificateEffectiveDate	1/15/2024
CertificateExpirationDate	1/14/2026
FacilityType	Waiver

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