10D0875450 CLIA NUMBER - NORTHWEST FLORIDA ASC LP

Laboratory Demographics

CLIA Number: 10D0875450

Facility Name: NORTHWEST FLORIDA ASC LP

Facility Address:
204 B EAST 19TH STREET
PANAMA CITY, FL
ZIP 32405
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Facility Phone Number: 850 769-7599

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1992785232

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D0875450
LAB Type	Ambulatory Surgery Center
Facility Name	NORTHWEST FLORIDA ASC LP
Street	204 B EAST 19TH STREET
City	PANAMA CITY
State	FL
ZIP	32405
Phone	850 769-7599
CertificateType	4
CertificateEffectiveDate	8/23/2023
CertificateExpirationDate	8/22/2025
FacilityType	Waiver

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