10D2127897 CLIA NUMBER - WAUCHULA OUTPATIENT OFFICE

Laboratory Demographics

  • CLIA Code: 10D2127897
  • Facility Name: WAUCHULA OUTPATIENT OFFICE
  • Facility Address: 213 EAST ORANGE AVENUE SUITE B
    WAUCHULA, FL
    ZIP 33873
  • Facility Phone: 863 519-0575
  • Facility Type: Other - MENTAL HEALTH
  • Facility Type: Waiver
  • Lab Director: MIGNON BURR
  • NPI Number: 1972552867
  • Taxonomy: 207P00000X - Emergency Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D2127897
LAB Type Other - MENTAL HEALTH
Facility Name WAUCHULA OUTPATIENT OFFICE
Street 213 EAST ORANGE AVENUE SUITE B
City WAUCHULA
State FL
ZIP 33873
Phone 863 519-0575
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/21/2025
Certificate Expiration Date 3/20/2027
Facility Type Other - MENTAL HEALTH
Lab Director MIGNON BURR

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