10D1066216 CLIA NUMBER - PALM MEDICAL CENTER LAKELAND, LLC

Laboratory Demographics

CLIA Number: 10D1066216

Facility Name: PALM MEDICAL CENTER LAKELAND, LLC

Facility Address:
613 W MARTIN LUTHER KING BLVD
TAMPA, FL
ZIP 33603
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Facility Phone Number: 813 237-1958

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1932772803

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	10D1066216
LAB Type	Physician Office
Facility Name	PALM MEDICAL CENTER LAKELAND, LLC
Street	613 W MARTIN LUTHER KING BLVD
City	TAMPA
State	FL
ZIP	33603
Phone	813 237-1958
CertificateType	4
CertificateEffectiveDate	3/19/2023
CertificateExpirationDate	3/18/2025
FacilityType	Waiver

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