10D2053191 CLIA NUMBER - MEDICAL HOME ALLIANCE LLC

Laboratory Demographics

  • CLIA Code: 10D2053191
  • Facility Name: MEDICAL HOME ALLIANCE LLC
  • Facility Address: 199 SE AVE K
    WINTER HAVEN, FL
    ZIP 33880
  • Facility Phone: 863 588-1424
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KAROL FORTICH SERJE
  • NPI Number: 1770093916
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D2053191
LAB Type Physician Office
Facility Name MEDICAL HOME ALLIANCE LLC
Street 199 SE AVE K
City WINTER HAVEN
State FL
ZIP 33880
Phone 863 588-1424
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/28/2025
Certificate Expiration Date 1/27/2027
Facility Type Physician Office
Lab Director KAROL FORTICH SERJE

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