10D1008495 CLIA NUMBER - PALM MEDICAL CENTER LAKELAND LLC

Laboratory Demographics

CLIA Number: 10D1008495

Facility Name: PALM MEDICAL CENTER LAKELAND LLC

Facility Address:
2250 OSPREY BLVD BLDG A STE 101
BARTOW, FL
ZIP 33830
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Facility Phone Number: 305 913-9444

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1336580976

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	10D1008495
LAB Type	Physician Office
Facility Name	PALM MEDICAL CENTER LAKELAND LLC
Street	2250 OSPREY BLVD BLDG A STE 101
City	BARTOW
State	FL
ZIP	33830
Phone	305 913-9444
CertificateType	4
CertificateEffectiveDate	1/22/2023
CertificateExpirationDate	1/21/2025
FacilityType	Waiver

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