10D2065501 CLIA NUMBER - BLACK SHEEP MEDICAL

Laboratory Demographics

  • CLIA Code: 10D2065501
  • Facility Name: BLACK SHEEP MEDICAL
  • Facility Address: 1425 HAND AVE STE L
    ORMOND BEACH, FL
    ZIP 32174
  • Facility Phone: 386 256-3977
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOHN R. CHEWNING
  • NPI Number: 1992134712
  • Taxonomy: 332900000X - Non-Pharmacy Dispensing Site

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CLIA Record

Field Name Field Value
CLIA Number 10D2065501
LAB Type Physician Office
Facility Name BLACK SHEEP MEDICAL
Street 1425 HAND AVE STE L
City ORMOND BEACH
State FL
ZIP 32174
Phone 386 256-3977
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/10/2025
Certificate Expiration Date 9/9/2027
Facility Type Physician Office
Lab Director JOHN R. CHEWNING

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