10D1103302 CLIA NUMBER - JFK INTERNAL MEDICINE FACULTY PRACTICE

Laboratory Demographics

CLIA Number: 10D1103302

Facility Name: JFK INTERNAL MEDICINE FACULTY PRACTICE

Facility Address:
180 JFK DR STE 210
ATLANTIS, FL
ZIP 33462
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Facility Phone Number: 561 548-1450

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1467614651

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	10D1103302
LAB Type	Physician Office
Facility Name	JFK INTERNAL MEDICINE FACULTY PRACTICE
Street	180 JFK DR STE 210
City	ATLANTIS
State	FL
ZIP	33462
Phone	561 548-1450
CertificateType	4
CertificateEffectiveDate	8/7/2023
CertificateExpirationDate	8/6/2025
FacilityType	Waiver

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