10D1026432 CLIA NUMBER - GLORY MEDCLINIC LLC

Laboratory Demographics

  • CLIA Code: 10D1026432
  • Facility Name: GLORY MEDCLINIC LLC
  • Facility Address: 8019 N HIMES AVE, STE 200
    TAMPA, FL
    ZIP 33614
  • Facility Phone: 813 932-9798
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DAVID IKUDAYISI
  • NPI Number: 1427472364
  • Taxonomy: 261QH0100X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D1026432
LAB Type Physician Office
Facility Name GLORY MEDCLINIC LLC
Street 8019 N HIMES AVE, STE 200
City TAMPA
State FL
ZIP 33614
Phone 813 932-9798
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/4/2024
Certificate Expiration Date 6/3/2026
Facility Type Physician Office
Lab Director DAVID IKUDAYISI

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