10D2079539 CLIA NUMBER - ST AUGUSTINE HOME TRAINING

Laboratory Demographics

  • CLIA Code: 10D2079539
  • Facility Name: ST AUGUSTINE HOME TRAINING
  • Facility Address: 252 SOUTHPARK CIR E
    SAINT AUGUSTINE, FL
    ZIP 32086
  • Facility Phone: 904 823-1594
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: AMIR A. MALIK
  • NPI Number: 1760892459
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D2079539
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name ST AUGUSTINE HOME TRAINING
Street 252 SOUTHPARK CIR E
City SAINT AUGUSTINE
State FL
ZIP 32086
Phone 904 823-1594
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/18/2024
Certificate Expiration Date 6/17/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director AMIR A. MALIK

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