10D2020717 CLIA NUMBER - TUI FAMILY MEDICINE PL

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Laboratory Demographics

CLIA Number: 10D2020717

Facility Name: TUI FAMILY MEDICINE PL

Facility Address:
4554 CLYDE MORRIS BLVD STE 2
PORT ORANGE, FL
ZIP 32129
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Facility Phone Number: 386 304-2990

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1386940013

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	10D2020717
LAB Type	Physician Office
Facility Name	TUI FAMILY MEDICINE PL
Street	4554 CLYDE MORRIS BLVD STE 2
City	PORT ORANGE
State	FL
ZIP	32129
Phone	386 304-2990
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