10D1053888 CLIA NUMBER - PHYSICIANS GROUP LLC - DE

Laboratory Demographics

  • CLIA Code: 10D1053888
  • Facility Name: PHYSICIANS GROUP LLC - DE
  • Facility Address: 4221 N HIMES AVE
    TAMPA, FL
    ZIP 33607
  • Facility Phone: 813 874-7217
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. GREGORY A. BRONNER
  • NPI Number: 1700246204
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 10D1053888
LAB Type Physician Office
Facility Name PHYSICIANS GROUP LLC - DE
Street 4221 N HIMES AVE
City TAMPA
State FL
ZIP 33607
Phone 813 874-7217
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/8/2024
Certificate Expiration Date 5/7/2026
Facility Type Physician Office
Lab Director DR. GREGORY A. BRONNER

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