10D2020675 CLIA NUMBER - SACRED HEART MEDICAL GROUP

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Laboratory Demographics

CLIA Number: 10D2020675

Facility Name: SACRED HEART MEDICAL GROUP

Facility Address:
4586 HWY 20 STE A
NICEVILLE, FL
ZIP 32578
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Facility Phone Number: 850 897-0110

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1700555257

Taxonomy: 207V00000X - Obstetrics & Gynecology
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.

CLIA Record

Field Name	Field Value
CLIA Number	10D2020675
LAB Type	Physician Office
Facility Name	SACRED HEART MEDICAL GROUP
Street	4586 HWY 20 STE A
City	NICEVILLE
State	FL
ZIP	32578
Phone	850 897-0110
CertificateType	4
CertificateEffectiveDate	2/25/2023
CertificateExpirationDate	2/24/2025
FacilityType	Waiver

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