10D2035543 CLIA NUMBER - COMMUNITY MEDICAL CENTER

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Laboratory Demographics

CLIA Number: 10D2035543

Facility Name: COMMUNITY MEDICAL CENTER

Facility Address:
126 S COUNTY RD STE 315
INTERLACHEN, FL
ZIP 32148
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Facility Phone Number: 386 684-4685

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1639437569

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2035543
LAB Type	Physician Office
Facility Name	COMMUNITY MEDICAL CENTER
Street	126 S COUNTY RD STE 315
City	INTERLACHEN
State	FL
ZIP	32148
Phone	386 684-4685
CertificateType	4
CertificateEffectiveDate	1/19/2024
CertificateExpirationDate	1/18/2026
FacilityType	Waiver

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