10D2095704 CLIA NUMBER - COMMUNITY HOSPITAL FAMILY PRACTICE LLC

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Laboratory Demographics

CLIA Number: 10D2095704

Facility Name: COMMUNITY HOSPITAL FAMILY PRACTICE LLC

Facility Address:
11371 CORTEZ BLVD STE #223
BROOKSVILLE, FL
ZIP 34613
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Facility Phone Number: 352 596-8911

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1407865942

Taxonomy: 207VG0400X - Obstetrics & Gynecology
A physician who specializes in diagnosis, treatment, and management of patients with gynecologic conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	10D2095704
LAB Type	Physician Office
Facility Name	COMMUNITY HOSPITAL FAMILY PRACTICE LLC
Street	11371 CORTEZ BLVD STE #223
City	BROOKSVILLE
State	FL
ZIP	34613
Phone	352 596-8911
CertificateType	4
CertificateEffectiveDate	5/11/2023
CertificateExpirationDate	5/10/2025
FacilityType	Waiver

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