10D0918695 CLIA NUMBER - MEDICAL CENTER CLINIC PA SURGICAL CENTER

Laboratory Demographics

CLIA Number: 10D0918695

Facility Name: MEDICAL CENTER CLINIC PA SURGICAL CENTER

Facility Address:
8333 N DAVIS HIGHWAY
PENSACOLA, FL
ZIP 32514
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Facility Phone Number: 850 969-2121

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1043396245

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D0918695
LAB Type	Ambulatory Surgery Center
Facility Name	MEDICAL CENTER CLINIC PA SURGICAL CENTER
Street	8333 N DAVIS HIGHWAY
City	PENSACOLA
State	FL
ZIP	32514
Phone	850 969-2121
CertificateType	4
CertificateEffectiveDate	8/19/2022
CertificateExpirationDate	8/18/2024
FacilityType	Waiver

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