10D2150857 CLIA NUMBER - PREMISE HEALTH OF FLORIDA MEDICAL, PA

Laboratory Demographics

CLIA Number: 10D2150857

Facility Name: PREMISE HEALTH OF FLORIDA MEDICAL, PA

Facility Address:
1111 LUCERNE TERRACE
ORLANDO, FL
ZIP 32806
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Facility Phone Number: 407 269-8531

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1770257834

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2150857
LAB Type	Physician Office
Facility Name	PREMISE HEALTH OF FLORIDA MEDICAL, PA
Street	1111 LUCERNE TERRACE
City	ORLANDO
State	FL
ZIP	32806
Phone	407 269-8531
CertificateType	4
CertificateEffectiveDate	7/6/2022
CertificateExpirationDate	7/5/2024
FacilityType	Waiver

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