10D2153516 CLIA NUMBER - MICANOPY HEALTH & WELLNESS

Laboratory Demographics

CLIA Number: 10D2153516

Facility Name: MICANOPY HEALTH & WELLNESS

Facility Address:
504 NE CHOLOKKA BLVD
MICANOPY, FL
ZIP 32667
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Facility Phone Number: 354 466-4600

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1114419769

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	10D2153516
LAB Type	Physician Office
Facility Name	MICANOPY HEALTH & WELLNESS
Street	504 NE CHOLOKKA BLVD
City	MICANOPY
State	FL
ZIP	32667
Phone	354 466-4600
CertificateType	4
CertificateEffectiveDate	8/27/2022
CertificateExpirationDate	8/26/2024
FacilityType	Waiver

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