10D0953367 CLIA NUMBER - PREMISE HEALTH OF FLORIDA MEDICAL, PA

Laboratory Demographics

CLIA Number: 10D0953367

Facility Name: PREMISE HEALTH OF FLORIDA MEDICAL, PA

Facility Address:
100 GLOBAL INNOVATION CIRCLE BLDG E2
ORLANDO, FL
ZIP 32825
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Facility Phone Number: 407 306-2002

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1174042600

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	10D0953367
LAB Type	Physician Office
Facility Name	PREMISE HEALTH OF FLORIDA MEDICAL, PA
Street	100 GLOBAL INNOVATION CIRCLE BLDG E2
City	ORLANDO
State	FL
ZIP	32825
Phone	407 306-2002
CertificateType	4
CertificateEffectiveDate	11/2/2022
CertificateExpirationDate	11/1/2024
FacilityType	Waiver

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