10D2059104 CLIA NUMBER - PHOENIX HEALTH ASCENDENCY LLC

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Laboratory Demographics

CLIA Number: 10D2059104

Facility Name: PHOENIX HEALTH ASCENDENCY LLC

Facility Address:
17011 FL-50 SUITE 103
CLERMONT, FL
ZIP 34711
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Facility Phone Number: 352 352-2208

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1316418577

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2059104
LAB Type	Physician Office
Facility Name	PHOENIX HEALTH ASCENDENCY LLC
Street	17011 FL-50 SUITE 103
City	CLERMONT
State	FL
ZIP	34711
Phone	352 352-2208
CertificateType	4
CertificateEffectiveDate	5/17/2023
CertificateExpirationDate	5/16/2025
FacilityType	Waiver

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