10D2149683 CLIA NUMBER - SAINT GEORGE MEDICAL CENTER INC

Laboratory Demographics

CLIA Number: 10D2149683

Facility Name: SAINT GEORGE MEDICAL CENTER INC

Facility Address:
1118 HOSPITAL ROAD
FORT WALTON BEACH, FL
ZIP 32547
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Facility Phone Number: 850 862-3415

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1184137929

Taxonomy: 207QG0300X - Family Medicine
A family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital.

CLIA Record

Field Name	Field Value
CLIA Number	10D2149683
LAB Type	Physician Office
Facility Name	SAINT GEORGE MEDICAL CENTER INC
Street	1118 HOSPITAL ROAD
City	FORT WALTON BEACH
State	FL
ZIP	32547
Phone	850 862-3415
CertificateType	4
CertificateEffectiveDate	6/8/2022
CertificateExpirationDate	6/7/2024
FacilityType	Waiver

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