10D2047735 CLIA NUMBER - PEDIATRIC PHYSICIAN SERVICES INC

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Laboratory Demographics

CLIA Number: 10D2047735

Facility Name: PEDIATRIC PHYSICIAN SERVICES INC

Facility Address:
3310 LAKELAND HILLS BLVD
LAKELAND, FL
ZIP 33805
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Facility Phone Number: 813 631-5000

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1053747188

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2047735
LAB Type	Physician Office
Facility Name	PEDIATRIC PHYSICIAN SERVICES INC
Street	3310 LAKELAND HILLS BLVD
City	LAKELAND
State	FL
ZIP	33805
Phone	813 631-5000
CertificateType	4
CertificateEffectiveDate	10/2/2022
CertificateExpirationDate	10/1/2024
FacilityType	Waiver

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