10D2112775 CLIA NUMBER - TLC MEDICAL CENTER LLC

Laboratory Demographics

CLIA Number: 10D2112775

Facility Name: TLC MEDICAL CENTER LLC

Facility Address:
2040 COLLIER AVE STE A
FORT MYERS, FL
ZIP 33901
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Facility Phone Number: 239 208-7756

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1295102598

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	10D2112775
LAB Type	Physician Office
Facility Name	TLC MEDICAL CENTER LLC
Street	2040 COLLIER AVE STE A
City	FORT MYERS
State	FL
ZIP	33901
Phone	239 208-7756
CertificateType	4
CertificateEffectiveDate	5/9/2022
CertificateExpirationDate	5/8/2024
FacilityType	Waiver

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