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10D1085687 CLIA NUMBER - MAIN STREET MEDICAL CENTER OF CRESTVIEW PA

Laboratory Demographics

CLIA Number: 10D1085687

Facility Name: MAIN STREET MEDICAL CENTER OF CRESTVIEW PA

Facility Address:
369 N MAIN ST
CRESTVIEW, FL
ZIP 32536
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Facility Phone Number: 850 398-6963

Facility Type: Mobile Laboratory

Certificate Type: Waiver
NPI Number: 1619181914

Taxonomy: 207R00000X - Internal Medicine
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

CLIA Record

Field Name Field Value
CLIA Number 10D1085687
LAB Type Mobile Laboratory
Facility Name MAIN STREET MEDICAL CENTER OF CRESTVIEW PA
Street 369 N MAIN ST
City CRESTVIEW
State FL
ZIP 32536
Phone 850 398-6963
CertificateType 4
CertificateEffectiveDate 6/24/2022
CertificateExpirationDate 6/23/2024
FacilityType Waiver

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