10D1055352 CLIA NUMBER - PREMIER CARE PEDIATRICS PA

Laboratory Demographics

  • CLIA Code: 10D1055352
  • Facility Name: PREMIER CARE PEDIATRICS PA
  • Facility Address: 16637 FISHHAWK BLVD STE 101
    LITHIA, FL
    ZIP 33547
  • Facility Phone: 813 657-7337
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MATTHEW C. MINICK
  • NPI Number: 1346442506
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 10D1055352
LAB Type Physician Office
Facility Name PREMIER CARE PEDIATRICS PA
Street 16637 FISHHAWK BLVD STE 101
City LITHIA
State FL
ZIP 33547
Phone 813 657-7337
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/15/2024
Certificate Expiration Date 6/14/2026
Facility Type Physician Office
Lab Director MATTHEW C. MINICK

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