10D0887803 CLIA NUMBER - PREMISE HEALTH OF FLORIDA MEDICAL, PA

Laboratory Demographics

CLIA Number: 10D0887803

Facility Name: PREMISE HEALTH OF FLORIDA MEDICAL, PA

Facility Address:
17200 COMMERCE PARK BLVD
TAMPA, FL
ZIP 33647
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Facility Phone Number: 813 615-6394

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1457886111

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D0887803
LAB Type	Physician Office
Facility Name	PREMISE HEALTH OF FLORIDA MEDICAL, PA
Street	17200 COMMERCE PARK BLVD
City	TAMPA
State	FL
ZIP	33647
Phone	813 615-6394
CertificateType	4
CertificateEffectiveDate	6/17/2022
CertificateExpirationDate	6/16/2024
FacilityType	Waiver

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