10D1041032 CLIA NUMBER - ORLANDO FAMILY PHYSICIANS, LLC DBA WATERS MEDICAL CLINIC

Laboratory Demographics

CLIA Number: 10D1041032

Facility Name: ORLANDO FAMILY PHYSICIANS, LLC DBA WATERS MEDICAL CLINIC

Facility Address:
8408 N GRADY AVE
TAMPA, FL
ZIP 33614
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Facility Phone Number: 813 885-9091

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1336467208

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D1041032
LAB Type	Physician Office
Facility Name	ORLANDO FAMILY PHYSICIANS, LLC DBA WATERS MEDICAL CLINIC
Street	8408 N GRADY AVE
City	TAMPA
State	FL
ZIP	33614
Phone	813 885-9091
CertificateType	4
CertificateEffectiveDate	5/24/2023
CertificateExpirationDate	5/23/2025
FacilityType	Waiver

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