10D2158833 CLIA NUMBER - CLERMONT RADIOLOGY - KINGS RIDGE

Laboratory Demographics

CLIA Number: 10D2158833

Facility Name: CLERMONT RADIOLOGY - KINGS RIDGE

Facility Address:
3725 SOUTH HIGHWAY 27 SUITE 104
CLERMONT, FL
ZIP 34711
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Facility Phone Number: 352 241-6100

Facility Type: Other - IDTF

Certificate Type: Waiver

NPI Number: 1003328642

Taxonomy: 261QR0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2158833
LAB Type	Other - IDTF
Facility Name	CLERMONT RADIOLOGY - KINGS RIDGE
Street	3725 SOUTH HIGHWAY 27 SUITE 104
City	CLERMONT
State	FL
ZIP	34711
Phone	352 241-6100
CertificateType	4
CertificateEffectiveDate	12/7/2022
CertificateExpirationDate	12/6/2024
FacilityType	Waiver

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