10D1055842 CLIA NUMBER - INGRAM PEDIATRICS

Laboratory Demographics

CLIA Number: 10D1055842

Facility Name: INGRAM PEDIATRICS

Facility Address:
4100 S HOSPITAL DR STE 302
PLANTATION, FL
ZIP 33317
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Facility Phone Number: (813) 784-8247

Facility Type: PHYSICIAN OFFICE

Certificate Type: Waiver

NPI Number: 1265581383

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D1055842
LAB Type	PHYSICIAN OFFICE
Facility Name	INGRAM PEDIATRICS
Street	4100 S HOSPITAL DR STE 302
City	PLANTATION
State	FL
ZIP	33317
Phone	(813) 784-8247

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This page was last updated on: 5/11/2023