10D1063847 CLIA NUMBER - BRADENTON RESEARCH CENTER

Laboratory Demographics

CLIA Number: 10D1063847

Facility Name: BRADENTON RESEARCH CENTER

Facility Address:
3924 9TH AVE W
BRADENTON, FL
ZIP 34205
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Facility Phone Number: 941 708-0005

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1164418182

Taxonomy: 2086S0129X - Surgery
A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.

CLIA Record

Field Name	Field Value
CLIA Number	10D1063847
LAB Type	Other
Facility Name	BRADENTON RESEARCH CENTER
Street	3924 9TH AVE W
City	BRADENTON
State	FL
ZIP	34205
Phone	941 708-0005
CertificateType	4
CertificateEffectiveDate	1/23/2023
CertificateExpirationDate	1/22/2025
FacilityType	Waiver

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