10D1105772 CLIA NUMBER - NORTH MAIN FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 10D1105772
  • Facility Name: NORTH MAIN FAMILY PRACTICE
  • Facility Address: 11565 NORTH MAIN ST STE 228
    JACKSONVILLE, FL
    ZIP 32218
  • Facility Phone: 904 757-2811
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ROY H. HINMAN
  • NPI Number: 1619223351
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D1105772
LAB Type Physician Office
Facility Name NORTH MAIN FAMILY PRACTICE
Street 11565 NORTH MAIN ST STE 228
City JACKSONVILLE
State FL
ZIP 32218
Phone 904 757-2811
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/28/2025
Certificate Expiration Date 9/27/2027
Facility Type Physician Office
Lab Director ROY H. HINMAN

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