10D1090710 CLIA NUMBER - HERITAGE PLACE AMBULATORY CENTER

Laboratory Demographics

  • CLIA Code: 10D1090710
  • Facility Name: HERITAGE PLACE AMBULATORY CENTER
  • Facility Address: 1040 RIVER HERITAGE BLVD STE 101
    BRADENTON, FL
    ZIP 34212
  • Facility Phone: 941 919-6865
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JASON M. TEDESCO
  • NPI Number: 1730593773
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 10D1090710
LAB Type Physician Office
Facility Name HERITAGE PLACE AMBULATORY CENTER
Street 1040 RIVER HERITAGE BLVD STE 101
City BRADENTON
State FL
ZIP 34212
Phone 941 919-6865
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/16/2025
Certificate Expiration Date 10/15/2027
Facility Type Physician Office
Lab Director JASON M. TEDESCO

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