10D2040276 CLIA NUMBER - GAINESVILLE PSYCHIATRY AND FORENSIC SERVICES LLC

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Laboratory Demographics

CLIA Number: 10D2040276

Facility Name: GAINESVILLE PSYCHIATRY AND FORENSIC SERVICES LLC

Facility Address:
1103 SW 2ND AVE
GAINESVILLE, FL
ZIP 32601
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Facility Phone Number: 352 378-9116

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1295756385

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2040276
LAB Type	Physician Office
Facility Name	GAINESVILLE PSYCHIATRY AND FORENSIC SERVICES LLC
Street	1103 SW 2ND AVE
City	GAINESVILLE
State	FL
ZIP	32601
Phone	352 378-9116
CertificateType	4
CertificateEffectiveDate	4/26/2024
CertificateExpirationDate	4/25/2026
FacilityType	Waiver

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