10D2035315 CLIA NUMBER - FORT PIERCE FAMILY CARE INC

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Laboratory Demographics

CLIA Number: 10D2035315

Facility Name: FORT PIERCE FAMILY CARE INC

Facility Address:
3851 VIRGINIA AVE
FORT PIERCE, FL
ZIP 34981
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Facility Phone Number: 772 882-4919

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1710271333

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2035315
LAB Type	Physician Office
Facility Name	FORT PIERCE FAMILY CARE INC
Street	3851 VIRGINIA AVE
City	FORT PIERCE
State	FL
ZIP	34981
Phone	772 882-4919
CertificateType	4
CertificateEffectiveDate	4/18/2024
CertificateExpirationDate	4/17/2026
FacilityType	Waiver

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