10D1080942 CLIA NUMBER - MID FLORIDA PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 10D1080942
  • Facility Name: MID FLORIDA PRIMARY CARE
  • Facility Address: 17809 SE 109TH AVE
    SUMMERFIELD, FL
    ZIP 34491
  • Facility Phone: 352 728-4242
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RAVI P. GUPTA MD
  • NPI Number: 1598827479
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D1080942
LAB Type Physician Office
Facility Name MID FLORIDA PRIMARY CARE
Street 17809 SE 109TH AVE
City SUMMERFIELD
State FL
ZIP 34491
Phone 352 728-4242
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/6/2024
Certificate Expiration Date 3/5/2026
Facility Type Physician Office
Lab Director RAVI P. GUPTA MD

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