10D1090798 CLIA NUMBER - GREATER TAMPA AT HOME

Laboratory Demographics

CLIA Number: 10D1090798

Facility Name: GREATER TAMPA AT HOME

Facility Address:
4204 N MACDILL AVE STE B
TAMPA, FL
ZIP 33607
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Facility Phone Number: 813 872-8216

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1205006228

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D1090798
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	GREATER TAMPA AT HOME
Street	4204 N MACDILL AVE STE B
City	TAMPA
State	FL
ZIP	33607
Phone	813 872-8216
CertificateType	4
CertificateEffectiveDate	10/20/2022
CertificateExpirationDate	10/19/2024
FacilityType	Waiver

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