10D1099224 CLIA NUMBER - CIRCLE OF HEALTH FAMILY PRACTICE

Laboratory Demographics

CLIA Number: 10D1099224

Facility Name: CIRCLE OF HEALTH FAMILY PRACTICE

Facility Address:
10 FLORIDA PARK DR UNIT B
PALM COAST, FL
ZIP 32137
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Facility Phone Number: 386 447-1803

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1417115528

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D1099224
LAB Type	Physician Office
Facility Name	CIRCLE OF HEALTH FAMILY PRACTICE
Street	10 FLORIDA PARK DR UNIT B
City	PALM COAST
State	FL
ZIP	32137
Phone	386 447-1803
CertificateType	4
CertificateEffectiveDate	5/8/2023
CertificateExpirationDate	5/7/2025
FacilityType	Waiver

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