10D2040636 CLIA NUMBER - FORT WALTON BEACH MEDICAL CENTER IMAGING DEPARTMEN

Laboratory Demographics

  • CLIA Code: 10D2040636
  • Facility Name: FORT WALTON BEACH MEDICAL CENTER IMAGING DEPARTMEN
  • Facility Address: 1032 MAR WALT DR STE 150
    FORT WALTON BEACH, FL
    ZIP 32547
  • Facility Phone: 850 863-7670
  • Facility Type: Ancillary Testing Site in Health Care Center
  • Facility Type: Waiver
  • Lab Director: NEIL ASTHANA
  • NPI Number: 1710522602
  • Taxonomy: 2085R0202X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 10D2040636
LAB Type Ancillary Testing Site in Health Care Center
Facility Name FORT WALTON BEACH MEDICAL CENTER IMAGING DEPARTMEN
Street 1032 MAR WALT DR STE 150
City FORT WALTON BEACH
State FL
ZIP 32547
Phone 850 863-7670
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/7/2024
Certificate Expiration Date 5/6/2026
Facility Type Ancillary Testing Site in Health Care Center
Lab Director NEIL ASTHANA

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