10D1026019 CLIA NUMBER - WHITE WILSON MEDICAL CENTER IMMEDIATE CARE FORT WALTON

Laboratory Demographics

  • CLIA Code: 10D1026019
  • Facility Name: WHITE WILSON MEDICAL CENTER IMMEDIATE CARE FORT WALTON
  • Facility Address: 1005 MAR WALT DR
    FORT WALTON BEACH, FL
    ZIP 32547
  • Facility Phone: 850 863-8284
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHINH V. VAN
  • NPI Number: 1831846336
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D1026019
LAB Type Physician Office
Facility Name WHITE WILSON MEDICAL CENTER IMMEDIATE CARE FORT WALTON
Street 1005 MAR WALT DR
City FORT WALTON BEACH
State FL
ZIP 32547
Phone 850 863-8284
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/25/2024
Certificate Expiration Date 5/24/2026
Facility Type Physician Office
Lab Director CHINH V. VAN

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