10D1089699 CLIA NUMBER - PASSPORT HEALTH OF TAMPA BAY

Laboratory Demographics

CLIA Number: 10D1089699

Facility Name: PASSPORT HEALTH OF TAMPA BAY

Facility Address:
4204 W LINEBAUGH AVE
TAMPA, FL
ZIP 33624
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Facility Phone Number: 813 969-3757

Facility Type: Health Fair

Certificate Type: Waiver

NPI Number: 1699968909

Taxonomy: 261QH0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D1089699
LAB Type	Health Fair
Facility Name	PASSPORT HEALTH OF TAMPA BAY
Street	4204 W LINEBAUGH AVE
City	TAMPA
State	FL
ZIP	33624
Phone	813 969-3757
CertificateType	4
CertificateEffectiveDate	9/24/2022
CertificateExpirationDate	9/23/2024
FacilityType	Waiver

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