10D2123741 CLIA NUMBER - ELLENTON FAMILY PRACTICE DIRECT

Laboratory Demographics

CLIA Number: 10D2123741

Facility Name: ELLENTON FAMILY PRACTICE DIRECT

Facility Address:
907 25TH DR, E
ELLENTON, FL
ZIP 34222
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Facility Phone Number: 941 417-7386

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1124471503

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	10D2123741
LAB Type	Physician Office
Facility Name	ELLENTON FAMILY PRACTICE DIRECT
Street	907 25TH DR, E
City	ELLENTON
State	FL
ZIP	34222
Phone	941 417-7386
CertificateType	4
CertificateEffectiveDate	12/30/2022
CertificateExpirationDate	12/29/2024
FacilityType	Waiver

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