10D2047213 CLIA NUMBER - NORTH HABANA SURGERY CENTER

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Laboratory Demographics

CLIA Number: 10D2047213

Facility Name: NORTH HABANA SURGERY CENTER

Facility Address:
4214 N HABANA AVE
TAMPA, FL
ZIP 33607
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Facility Phone Number: 813 872-2696

Facility Type: Ancillary Testing Site in Health Care Center

Certificate Type: Waiver

NPI Number: 1164733473

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2047213
LAB Type	Ancillary Testing Site in Health Care Center
Facility Name	NORTH HABANA SURGERY CENTER
Street	4214 N HABANA AVE
City	TAMPA
State	FL
ZIP	33607
Phone	813 872-2696
CertificateType	4
CertificateEffectiveDate	9/19/2022
CertificateExpirationDate	9/18/2024
FacilityType	Waiver

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