10D1043115 CLIA NUMBER - MILLENNIUM PHYSICIAN GROUP, LLC

Laboratory Demographics

  • CLIA Code: 10D1043115
  • Facility Name: MILLENNIUM PHYSICIAN GROUP, LLC
  • Facility Address: 12276 SAN JOSE BLVD - UNIT 617
    JACKSONVILLE, FL
    ZIP 32223
  • Facility Phone: 941 787-7665
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BOYD D. EVANS JR
  • NPI Number: 1124228119
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D1043115
LAB Type Physician Office
Facility Name MILLENNIUM PHYSICIAN GROUP, LLC
Street 12276 SAN JOSE BLVD - UNIT 617
City JACKSONVILLE
State FL
ZIP 32223
Phone 941 787-7665
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/18/2023
Certificate Expiration Date 7/17/2025
Facility Type Physician Office
Lab Director BOYD D. EVANS JR

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This page was last updated on: 6/4/2025