10D2146431 CLIA NUMBER - DEDICATED SENIOR MEDICAL CENTER - WESTSIDE

Laboratory Demographics

CLIA Number: 10D2146431

Facility Name: DEDICATED SENIOR MEDICAL CENTER - WESTSIDE

Facility Address:
6841 BLANDING BLVD
JACKSONVILLE, FL
ZIP 32244
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Facility Phone Number: 904 862-2175

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1114434206

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	10D2146431
LAB Type	Physician Office
Facility Name	DEDICATED SENIOR MEDICAL CENTER - WESTSIDE
Street	6841 BLANDING BLVD
City	JACKSONVILLE
State	FL
ZIP	32244
Phone	904 862-2175
CertificateType	4
CertificateEffectiveDate	3/29/2024
CertificateExpirationDate	3/28/2026
FacilityType	Waiver

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