10D2119318 CLIA NUMBER - SOUTH MANATEE PEDIATRICS

Laboratory Demographics

  • CLIA Code: 10D2119318
  • Facility Name: SOUTH MANATEE PEDIATRICS
  • Facility Address: 5108 15TH ST E SUITE 111
    BRADENTON, FL
    ZIP 34203
  • Facility Phone: 941 960-9907
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: DR. MONICA RIDER
  • NPI Number: 1386157584
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D2119318
LAB Type Federally Qualified Health Center
Facility Name SOUTH MANATEE PEDIATRICS
Street 5108 15TH ST E SUITE 111
City BRADENTON
State FL
ZIP 34203
Phone 941 960-9907
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/23/2024
Certificate Expiration Date 9/22/2026
Facility Type Federally Qualified Health Center
Lab Director DR. MONICA RIDER

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This page was last updated on: 9/29/2025