10D0968343 CLIA NUMBER - FAMILY MEDICINE AND REHAB INC

Laboratory Demographics

CLIA Number: 10D0968343

Facility Name: FAMILY MEDICINE AND REHAB INC

Facility Address:
7685 103RD ST STE 1
JACKSONVILLE, FL
ZIP 32210
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Facility Phone Number: 904 771-1116

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1578777504

Taxonomy: 261QH0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D0968343
LAB Type	Physician Office
Facility Name	FAMILY MEDICINE AND REHAB INC
Street	7685 103RD ST STE 1
City	JACKSONVILLE
State	FL
ZIP	32210
Phone	904 771-1116
CertificateType	4
CertificateEffectiveDate	4/1/2023
CertificateExpirationDate	3/31/2025
FacilityType	Waiver

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