10D2079319 CLIA NUMBER - GENESIS FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 10D2079319
  • Facility Name: GENESIS FAMILY PRACTICE
  • Facility Address: 1133 SAXON BLVD STE 200
    ORANGE CITY, FL
    ZIP 32763
  • Facility Phone: 386 228-9700
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JAY C. CHANMUGAM
  • NPI Number: 1447799242
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 10D2079319
LAB Type Physician Office
Facility Name GENESIS FAMILY PRACTICE
Street 1133 SAXON BLVD STE 200
City ORANGE CITY
State FL
ZIP 32763
Phone 386 228-9700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/13/2024
Certificate Expiration Date 6/12/2026
Facility Type Physician Office
Lab Director JAY C. CHANMUGAM

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