10D2147679 CLIA NUMBER - FAMILY MEDICAL GROUP OF TAMPA INC

Laboratory Demographics

CLIA Number: 10D2147679

Facility Name: FAMILY MEDICAL GROUP OF TAMPA INC

Facility Address:
8011 N HINES AVE #4
TAMPA, FL
ZIP 33614
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Facility Phone Number: 813 299-6322

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1073002218

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2147679
LAB Type	Physician Office
Facility Name	FAMILY MEDICAL GROUP OF TAMPA INC
Street	8011 N HINES AVE #4
City	TAMPA
State	FL
ZIP	33614
Phone	813 299-6322
CertificateType	4
CertificateEffectiveDate	4/24/2024
CertificateExpirationDate	4/23/2026
FacilityType	Waiver

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