10D1017168 CLIA NUMBER - FLORIDA MEDICAL CLINIC AMBULATORY SURGERY CENTER

Laboratory Demographics

CLIA Number: 10D1017168

Facility Name: FLORIDA MEDICAL CLINIC AMBULATORY SURGERY CENTER

Facility Address:
14547 BRUCE B DOWNS BLVD
TAMPA, FL
ZIP 33613
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Facility Phone Number: 813 610-5031

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1093322794

Taxonomy: 315P00000X - Intermediate Care Facility, Intellectual Disabilities
An intermediate care facility providing services for individuals with intellectual disabilities.

CLIA Record

Field Name	Field Value
CLIA Number	10D1017168
LAB Type	Ambulatory Surgery Center
Facility Name	FLORIDA MEDICAL CLINIC AMBULATORY SURGERY CENTER
Street	14547 BRUCE B DOWNS BLVD
City	TAMPA
State	FL
ZIP	33613
Phone	813 610-5031
CertificateType	4
CertificateEffectiveDate	9/18/2023
CertificateExpirationDate	9/17/2025
FacilityType	Waiver

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