10D1042914 CLIA NUMBER - TGH URGENT CARE POWERED BY FAST TRACK

Laboratory Demographics

CLIA Number: 10D1042914

Facility Name: TGH URGENT CARE POWERED BY FAST TRACK

Facility Address:
5464 LITHIA PINECREST RD
LITHIA, FL
ZIP 33547
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Facility Phone Number: 813 925-1903

Facility Type: Other - URGENT CARE CLINIC

Certificate Type: Waiver

NPI Number: 1285290130

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D1042914
LAB Type	Other - URGENT CARE CLINIC
Facility Name	TGH URGENT CARE POWERED BY FAST TRACK
Street	5464 LITHIA PINECREST RD
City	LITHIA
State	FL
ZIP	33547
Phone	813 925-1903
CertificateType	4
CertificateEffectiveDate	9/8/2023
CertificateExpirationDate	9/7/2025
FacilityType	Waiver

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