10D2060012 CLIA NUMBER - SOUTHERN RESPIRATORY

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Laboratory Demographics

CLIA Number: 10D2060012

Facility Name: SOUTHERN RESPIRATORY

Facility Address:
724 S ROSSITER ST
MOUNT DORA, FL
ZIP 32757
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Facility Phone Number: 352 385-9116

Facility Type: Other - RESPIRATORY SERVICES

Certificate Type: Waiver

NPI Number: 1306890876

Taxonomy: 332BX2000X - Durable Medical Equipment & Medical Supplies

CLIA Record

Field Name	Field Value
CLIA Number	10D2060012
LAB Type	Other - RESPIRATORY SERVICES
Facility Name	SOUTHERN RESPIRATORY
Street	724 S ROSSITER ST
City	MOUNT DORA
State	FL
ZIP	32757
Phone	352 385-9116
CertificateType	4
CertificateEffectiveDate	6/5/2023
CertificateExpirationDate	6/4/2025
FacilityType	Waiver

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