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10D0988828 CLIA NUMBER - COASTAL ORTHOPEDICS AND SPORTS MEDICINE OF SOUTHWEST FLORIDA

Laboratory Demographics

CLIA Number: 10D0988828

Facility Name: COASTAL ORTHOPEDICS AND SPORTS MEDICINE OF SOUTHWEST FLORIDA

Facility Address:
6202 17TH AVE W
BRADENTON, FL
ZIP 34209
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Facility Phone Number: 941 792-1404

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1811134794

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name Field Value
CLIA Number 10D0988828
LAB Type Physician Office
Facility Name COASTAL ORTHOPEDICS AND SPORTS MEDICINE OF SOUTHWEST FLORIDA
Street 6202 17TH AVE W
City BRADENTON
State FL
ZIP 34209
Phone 941 792-1404
CertificateType 4
CertificateEffectiveDate 7/10/2023
CertificateExpirationDate 7/9/2025
FacilityType Waiver

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