10D1043111 CLIA NUMBER - CONCENTRA - JACKSONVILLE SOUTHSIDE

Laboratory Demographics

CLIA Number: 10D1043111

Facility Name: CONCENTRA - JACKSONVILLE SOUTHSIDE

Facility Address:
5995-1 UNIVERSITY BLVD, W
JACKSONVILLE, FL
ZIP 32216
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Facility Phone Number: 904 737-7173

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1225567910

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D1043111
LAB Type	Physician Office
Facility Name	CONCENTRA - JACKSONVILLE SOUTHSIDE
Street	5995-1 UNIVERSITY BLVD, W
City	JACKSONVILLE
State	FL
ZIP	32216
Phone	904 737-7173
CertificateType	4
CertificateEffectiveDate	7/18/2023
CertificateExpirationDate	7/17/2025
FacilityType	Waiver

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