10D2005721 CLIA NUMBER - PREMIERE MEDICAL GROUP

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Laboratory Demographics

CLIA Number: 10D2005721

Facility Name: PREMIERE MEDICAL GROUP

Facility Address:
2107 DAIRY RD
MELBOURNE, FL
ZIP 32904
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Facility Phone Number: 321 676-7860

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1285813147

Taxonomy: 282N00000X - General Acute Care Hospital
An acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a wide population group. The hospital treats patients in an acute phase of illness or injury, characterized by a single episode or a fairly short duration, from which the patient returns to his or her normal or previous level of activity.

CLIA Record

Field Name	Field Value
CLIA Number	10D2005721
LAB Type	Physician Office
Facility Name	PREMIERE MEDICAL GROUP
Street	2107 DAIRY RD
City	MELBOURNE
State	FL
ZIP	32904
Phone	321 676-7860
CertificateType	4
CertificateEffectiveDate	4/2/2024
CertificateExpirationDate	4/1/2026
FacilityType	Waiver

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