10D2055116 CLIA NUMBER - LAKE MEDICAL IMAGING AND BREAST CENTER AT THE VILLAGES

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Laboratory Demographics

CLIA Number: 10D2055116

Facility Name: LAKE MEDICAL IMAGING AND BREAST CENTER AT THE VILLAGES

Facility Address:
1400 US HWY 441 N STE 510
THE VILLAGES, FL
ZIP 32159
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Facility Phone Number: 352 365-2583

Facility Type: Other - IMAGING CENTER

Certificate Type: Waiver

NPI Number: 1770541633

Taxonomy: 2085R0202X - Radiology
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

CLIA Record

Field Name	Field Value
CLIA Number	10D2055116
LAB Type	Other - IMAGING CENTER
Facility Name	LAKE MEDICAL IMAGING AND BREAST CENTER AT THE VILLAGES
Street	1400 US HWY 441 N STE 510
City	THE VILLAGES
State	FL
ZIP	32159
Phone	352 365-2583
CertificateType	4
CertificateEffectiveDate	3/6/2023
CertificateExpirationDate	3/5/2025
FacilityType	Waiver

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