10D2112494 CLIA NUMBER - DUVAL VASCULAR CENTER

Laboratory Demographics

CLIA Number: 10D2112494

Facility Name: DUVAL VASCULAR CENTER

Facility Address:
915 W MONROE ST STE 101
JACKSONVILLE, FL
ZIP 32204
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Facility Phone Number: 904 518-1398

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1013375195

Taxonomy: 261QM2500X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).

CLIA Record

Field Name	Field Value
CLIA Number	10D2112494
LAB Type	Physician Office
Facility Name	DUVAL VASCULAR CENTER
Street	915 W MONROE ST STE 101
City	JACKSONVILLE
State	FL
ZIP	32204
Phone	904 518-1398
CertificateType	4
CertificateEffectiveDate	5/2/2022
CertificateExpirationDate	5/1/2024
FacilityType	Waiver

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