10D1013625 CLIA NUMBER - MILLENNIUM PHYSICIAN GROUP, LLC

Laboratory Demographics

CLIA Number: 10D1013625

Facility Name: MILLENNIUM PHYSICIAN GROUP, LLC

Facility Address:
20205 CORTEZ BLVD UNIT A
BROOKSVILLE, FL
ZIP 34601
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Facility Phone Number: 352 796-5303

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1073131702

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	10D1013625
LAB Type	Physician Office
Facility Name	MILLENNIUM PHYSICIAN GROUP, LLC
Street	20205 CORTEZ BLVD UNIT A
City	BROOKSVILLE
State	FL
ZIP	34601
Phone	352 796-5303
CertificateType	4
CertificateEffectiveDate	6/12/2023
CertificateExpirationDate	6/11/2025
FacilityType	Waiver

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