10D2132906 CLIA NUMBER - GULF COAST HEALTHCARE SYSTEMS, INC

Laboratory Demographics

CLIA Number: 10D2132906

Facility Name: GULF COAST HEALTHCARE SYSTEMS, INC

Facility Address:
2724 5TH STREET WEST, SUITE B-C
LEHIGH ACRES, FL
ZIP 33971
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Facility Phone Number: 239 325-1310

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1134497167

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2132906
LAB Type	Physician Office
Facility Name	GULF COAST HEALTHCARE SYSTEMS, INC
Street	2724 5TH STREET WEST, SUITE B-C
City	LEHIGH ACRES
State	FL
ZIP	33971
Phone	239 325-1310
CertificateType	4
CertificateEffectiveDate	6/29/2023
CertificateExpirationDate	6/28/2025
FacilityType	Waiver

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