10D2149164 CLIA NUMBER - MAYO CLINIC MANGURIAN LABORATORY

Laboratory Demographics

CLIA Number: 10D2149164

Facility Name: MAYO CLINIC MANGURIAN LABORATORY

Facility Address:
4500 SAN PABLO ROAD MANGURIAN BLDG
JACKSONVILLE, FL
ZIP 32224
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Facility Phone Number: 904 953-0205

Facility Type: Ancillary Testing Site in Health Care Center

Certificate Type: Waiver

NPI Number: 1023405065

Taxonomy: 261QM2500X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).

CLIA Record

Field Name	Field Value
CLIA Number	10D2149164
LAB Type	Ancillary Testing Site in Health Care Center
Facility Name	MAYO CLINIC MANGURIAN LABORATORY
Street	4500 SAN PABLO ROAD MANGURIAN BLDG
City	JACKSONVILLE
State	FL
ZIP	32224
Phone	904 953-0205
CertificateType	4
CertificateEffectiveDate	5/25/2022
CertificateExpirationDate	5/24/2024
FacilityType	Waiver

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