10D2009645 CLIA NUMBER - BRAIN AND SPINE CENTER LLC

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Laboratory Demographics

CLIA Number: 10D2009645

Facility Name: BRAIN AND SPINE CENTER LLC

Facility Address:
2202 STATE AVE STE 201
PANAMA CITY, FL
ZIP 32405
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Facility Phone Number: 850 785-0029

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1992913040

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	10D2009645
LAB Type	Physician Office
Facility Name	BRAIN AND SPINE CENTER LLC
Street	2202 STATE AVE STE 201
City	PANAMA CITY
State	FL
ZIP	32405
Phone	850 785-0029
CertificateType	4
CertificateEffectiveDate	7/9/2022
CertificateExpirationDate	7/8/2024
FacilityType	Waiver

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