10D2119318 CLIA NUMBER - SOUTH MANATEE PEDIATRICS

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Laboratory Demographics

CLIA Number: 10D2119318

Facility Name: SOUTH MANATEE PEDIATRICS

Facility Address:
5108 15TH ST E SUITE 111
BRADENTON, FL
ZIP 34203
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Facility Phone Number: 941 960-9907

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1386157584

Taxonomy: 261QF0400X - Clinic/Center

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
CertificateType	4
CertificateEffectiveDate	9/23/2022
CertificateExpirationDate	9/22/2024
FacilityType	Waiver

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