10D2031194 CLIA NUMBER - EVERNORTH DIRECT HEALTH, LLC

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Laboratory Demographics

CLIA Number: 10D2031194

Facility Name: EVERNORTH DIRECT HEALTH, LLC

Facility Address:
14311 METROPOLIS AVE - STE 102
FORT MYERS, FL
ZIP 33912
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Facility Phone Number: 480 868-0646

Facility Type: Other - OUTPATIENT

Certificate Type: Waiver

NPI Number: 1063063089

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	10D2031194
LAB Type	Other - OUTPATIENT
Facility Name	EVERNORTH DIRECT HEALTH, LLC
Street	14311 METROPOLIS AVE - STE 102
City	FORT MYERS
State	FL
ZIP	33912
Phone	480 868-0646
CertificateType	4
CertificateEffectiveDate	10/14/2023
CertificateExpirationDate	10/13/2025
FacilityType	Waiver

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