10D2091997 CLIA NUMBER - BRADEN CLINIC LLC DBA MATER DEI CLINIC

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Laboratory Demographics

CLIA Number: 10D2091997

Facility Name: BRADEN CLINIC LLC DBA MATER DEI CLINIC

Facility Address:
5068 ANNUNCIATION CIR STE 111
AVE MARIA, FL
ZIP 34142
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Facility Phone Number: 239 867-4395

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1871901157

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2091997
LAB Type	Rural Health Clinic
Facility Name	BRADEN CLINIC LLC DBA MATER DEI CLINIC
Street	5068 ANNUNCIATION CIR STE 111
City	AVE MARIA
State	FL
ZIP	34142
Phone	239 867-4395
CertificateType	4
CertificateEffectiveDate	2/24/2023
CertificateExpirationDate	2/23/2025
FacilityType	Waiver

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