10D2047239 CLIA NUMBER - PRIMARY MEDICAL CLINIC

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Laboratory Demographics

CLIA Number: 10D2047239

Facility Name: PRIMARY MEDICAL CLINIC

Facility Address:
3427 BROOK CROSSING DR
BRANDON, FL
ZIP 33511
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Facility Phone Number: 813 654-5331

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1447514716

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2047239
LAB Type	Physician Office
Facility Name	PRIMARY MEDICAL CLINIC
Street	3427 BROOK CROSSING DR
City	BRANDON
State	FL
ZIP	33511
Phone	813 654-5331
CertificateType	4
CertificateEffectiveDate	9/20/2022
CertificateExpirationDate	9/19/2024
FacilityType	Waiver

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