10D1074297 CLIA NUMBER - SIMONMED IMAGING FLORIDA LLC DBA SIMONMED IMAGING PARK SOUTH

Laboratory Demographics

  • CLIA Code: 10D1074297
  • Facility Name: SIMONMED IMAGING FLORIDA LLC DBA SIMONMED IMAGING PARK SOUTH
  • Facility Address: 6215 21ST AVE W STE A
    BRADENTON, FL
    ZIP 34209
  • Facility Phone: 941 795-4449
  • Facility Type: Other - OUTPATIENT MED IMAGING
  • Facility Type: Waiver
  • Lab Director: REDDY K. VIJITHA
  • NPI Number: 1114597184
  • Taxonomy: 2085R0202X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 10D1074297
LAB Type Other - OUTPATIENT MED IMAGING
Facility Name SIMONMED IMAGING FLORIDA LLC DBA SIMONMED IMAGING PARK SOUTH
Street 6215 21ST AVE W STE A
City BRADENTON
State FL
ZIP 34209
Phone 941 795-4449
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/26/2025
Certificate Expiration Date 9/25/2027
Facility Type Other - OUTPATIENT MED IMAGING
Lab Director REDDY K. VIJITHA

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