10D0961639 CLIA NUMBER - PEDIATRIC PRIME CARE PA

Laboratory Demographics

  • CLIA Code: 10D0961639
  • Facility Name: PEDIATRIC PRIME CARE PA
  • Facility Address: 1801 SE HILLMOOR DRIVE SUITE A105
    PORT SAINT LUCIE, FL
    ZIP 34952
  • Facility Phone: 561 335-9949
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PRITHVI R. SAWH
  • NPI Number: 1881093276
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 10D0961639
LAB Type Physician Office
Facility Name PEDIATRIC PRIME CARE PA
Street 1801 SE HILLMOOR DRIVE SUITE A105
City PORT SAINT LUCIE
State FL
ZIP 34952
Phone 561 335-9949
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/15/2025
Certificate Expiration Date 8/14/2027
Facility Type Physician Office
Lab Director PRITHVI R. SAWH

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This page was last updated on: 9/29/2025