10D1100243 CLIA NUMBER - DR GEORGE VAN BUREN CHILDREN AND FAMILY HEALTHCARE CENTER

Laboratory Demographics

CLIA Number: 10D1100243

Facility Name: DR GEORGE VAN BUREN CHILDREN AND FAMILY HEALTHCARE CENTER

Facility Address:
712 39TH ST W
BRADENTON, FL
ZIP 34205
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Facility Phone Number: 941 960-9907

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1871523795

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D1100243
LAB Type	Physician Office
Facility Name	DR GEORGE VAN BUREN CHILDREN AND FAMILY HEALTHCARE CENTER
Street	712 39TH ST W
City	BRADENTON
State	FL
ZIP	34205
Phone	941 960-9907
CertificateType	4
CertificateEffectiveDate	6/2/2023
CertificateExpirationDate	6/1/2025
FacilityType	Waiver

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