10D0898737 CLIA NUMBER - GATEWAY MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 10D0898737
  • Facility Name: GATEWAY MEDICAL CLINIC
  • Facility Address: 127 E REDSTONE AVE STE C
    CRESTVIEW, FL
    ZIP 32539
  • Facility Phone: (850) 423-0061
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: NORTH J. DAVIS
  • NPI Number: 1629026133
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D0898737
LAB Type Rural Health Clinic
Facility Name GATEWAY MEDICAL CLINIC
Street 127 E REDSTONE AVE STE C
City CRESTVIEW
State FL
ZIP 32539
Phone 8504230061
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/12/2025
Certificate Expiration Date 3/11/2027
Facility Type Rural Health Clinic
Lab Director NORTH J. DAVIS

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This page was last updated on: 6/29/2026