10D2102260 CLIA NUMBER - BAPTIST HEALTH MEDICAL GROUP PHYSICIANS, LLC

Laboratory Demographics

CLIA Number: 10D2102260

Facility Name: BAPTIST HEALTH MEDICAL GROUP PHYSICIANS, LLC

Facility Address:
13101 S DIXIE HWY STE 400
PINECREST, FL
ZIP 33156
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Facility Phone Number: 786 467-5700

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1104290048

Taxonomy: 261QE0002X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2102260
LAB Type	Physician Office
Facility Name	BAPTIST HEALTH MEDICAL GROUP PHYSICIANS, LLC
Street	13101 S DIXIE HWY STE 400
City	PINECREST
State	FL
ZIP	33156
Phone	786 467-5700
CertificateType	4
CertificateEffectiveDate	5/10/2023
CertificateExpirationDate	5/9/2025
FacilityType	Waiver

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