10D2030963 CLIA NUMBER - PORT CHARLOTTE HMA PHYSICIAN MANAGEMENT LLC

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Laboratory Demographics

CLIA Number: 10D2030963

Facility Name: PORT CHARLOTTE HMA PHYSICIAN MANAGEMENT LLC

Facility Address:
713 E MARION AVE SUITE 139
PUNTA GORDA, FL
ZIP 33950
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Facility Phone Number: 941 833-1750

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1467129791

Taxonomy: 207RG0100X - Internal Medicine
An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs.

CLIA Record

Field Name	Field Value
CLIA Number	10D2030963
LAB Type	Physician Office
Facility Name	PORT CHARLOTTE HMA PHYSICIAN MANAGEMENT LLC
Street	713 E MARION AVE SUITE 139
City	PUNTA GORDA
State	FL
ZIP	33950
Phone	941 833-1750
CertificateType	4
CertificateEffectiveDate	10/10/2023
CertificateExpirationDate	10/9/2025
FacilityType	Waiver

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