10D2052738 CLIA NUMBER - FIRST COAST HEART AND VASCULAR CENTER PLLC

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Laboratory Demographics

CLIA Number: 10D2052738

Facility Name: FIRST COAST HEART AND VASCULAR CENTER PLLC

Facility Address:
100 WHETSTONE PLACE STE 102
SAINT AUGUSTINE, FL
ZIP 32086
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Facility Phone Number: 904 423-0010

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1366795742

Taxonomy: 207RC0000X - Internal Medicine
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.

CLIA Record

Field Name	Field Value
CLIA Number	10D2052738
LAB Type	Physician Office
Facility Name	FIRST COAST HEART AND VASCULAR CENTER PLLC
Street	100 WHETSTONE PLACE STE 102
City	SAINT AUGUSTINE
State	FL
ZIP	32086
Phone	904 423-0010
CertificateType	4
CertificateEffectiveDate	1/17/2023
CertificateExpirationDate	1/16/2025
FacilityType	Waiver

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