10D2151748 CLIA NUMBER - MAJOR IMPACT, INC

Laboratory Demographics

CLIA Number: 10D2151748

Facility Name: MAJOR IMPACT, INC

Facility Address:
1960 VELASCO ST STE J-2
FORT MYERS, FL
ZIP 33916
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Facility Phone Number: 239 226-4357

Facility Type: Independent

Certificate Type: Waiver

NPI Number: 1114650728

Taxonomy: 101YA0400X - Counselor

CLIA Record

Field Name	Field Value
CLIA Number	10D2151748
LAB Type	Independent
Facility Name	MAJOR IMPACT, INC
Street	1960 VELASCO ST STE J-2
City	FORT MYERS
State	FL
ZIP	33916
Phone	239 226-4357
CertificateType	4
CertificateEffectiveDate	7/26/2022
CertificateExpirationDate	7/25/2024
FacilityType	Waiver

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