10D2106774 CLIA NUMBER - PEDIATRIC MEDICAL CENTER

Laboratory Demographics

CLIA Number: 10D2106774

Facility Name: PEDIATRIC MEDICAL CENTER

Facility Address:
724 CHARLES ST
ORLANDO, FL
ZIP 32808
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Facility Phone Number: 407 295-2039

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1952012429

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2106774
LAB Type	Physician Office
Facility Name	PEDIATRIC MEDICAL CENTER
Street	724 CHARLES ST
City	ORLANDO
State	FL
ZIP	32808
Phone	407 295-2039
CertificateType	4
CertificateEffectiveDate	12/29/2023
CertificateExpirationDate	12/28/2025
FacilityType	Waiver

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