10D2064483 CLIA NUMBER - ADVENTHEALTH MEDICAL GROUP MULTISPECIALTY AT NEW TAMPA

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Laboratory Demographics

CLIA Number: 10D2064483

Facility Name: ADVENTHEALTH MEDICAL GROUP MULTISPECIALTY AT NEW TAMPA

Facility Address:
8702 HUNTERS LAKE DR - STE 100
TAMPA, FL
ZIP 33647
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Facility Phone Number: 813 929-5330

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1821689233

Taxonomy: 261QR0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2064483
LAB Type	Physician Office
Facility Name	ADVENTHEALTH MEDICAL GROUP MULTISPECIALTY AT NEW TAMPA
Street	8702 HUNTERS LAKE DR - STE 100
City	TAMPA
State	FL
ZIP	33647
Phone	813 929-5330
CertificateType	4
CertificateEffectiveDate	8/20/2023
CertificateExpirationDate	8/19/2025
FacilityType	Waiver

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