10D0967903 CLIA NUMBER - ORMOND INTERNAL MEDICINE LLC

Laboratory Demographics

  • CLIA Code: 10D0967903
  • Facility Name: ORMOND INTERNAL MEDICINE LLC
  • Facility Address: 279 S YONGE ST
    ORMOND BEACH, FL
    ZIP 32174
  • Facility Phone: 386 673-2133
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GAIL VAN DIEPEN
  • NPI Number: 1023209095
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D0967903
LAB Type Physician Office
Facility Name ORMOND INTERNAL MEDICINE LLC
Street 279 S YONGE ST
City ORMOND BEACH
State FL
ZIP 32174
Phone 386 673-2133
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/10/2024
Certificate Expiration Date 8/9/2026
Facility Type Physician Office
Lab Director GAIL VAN DIEPEN

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