10D2037940 CLIA NUMBER - GRACE PEDIATRICS

Laboratory Demographics

  • CLIA Code: 10D2037940
  • Facility Name: GRACE PEDIATRICS
  • Facility Address: 4196 W US HWY 90 STE 105
    LAKE CITY, FL
    ZIP 32055
  • Facility Phone: 386 243-8474
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: COLLEEN A. THOMPSON
  • NPI Number: 1720362429
  • Taxonomy: 363LP0200X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 10D2037940
LAB Type Physician Office
Facility Name GRACE PEDIATRICS
Street 4196 W US HWY 90 STE 105
City LAKE CITY
State FL
ZIP 32055
Phone 386 243-8474
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/9/2024
Certificate Expiration Date 3/8/2026
Facility Type Physician Office
Lab Director COLLEEN A. THOMPSON

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This page was last updated on: 9/29/2025