10D0993389 CLIA NUMBER - MILLENNIUM PHYSICIAN GROUP, LLC

Laboratory Demographics

  • CLIA Code: 10D0993389
  • Facility Name: MILLENNIUM PHYSICIAN GROUP, LLC
  • Facility Address: 1555 KINGSLEY AVENUE SUITE 604
    ORANGE PARK, FL
    ZIP 32073
  • Facility Phone: 941 787-7665
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LEON A. YASAY JR
  • NPI Number: 1538831391
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D0993389
LAB Type Physician Office
Facility Name MILLENNIUM PHYSICIAN GROUP, LLC
Street 1555 KINGSLEY AVENUE SUITE 604
City ORANGE PARK
State FL
ZIP 32073
Phone 941 787-7665
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/14/2023
Certificate Expiration Date 11/13/2025
Facility Type Physician Office
Lab Director LEON A. YASAY JR

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