10D2159832 CLIA NUMBER - ST JOSEPHS CHILDRENS HOSPITAL PEDI TRANSPORT

Laboratory Demographics

CLIA Number: 10D2159832

Facility Name: ST JOSEPHS CHILDRENS HOSPITAL PEDI TRANSPORT

Facility Address:
3006 W DR MARTIN LUTHER KING JR BLVD MS 3032
TAMPA, FL
ZIP 33607
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Facility Phone Number: 813 870-4226

Facility Type: Ambulance

Certificate Type: Waiver

NPI Number: 1740261189

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2159832
LAB Type	Ambulance
Facility Name	ST JOSEPHS CHILDRENS HOSPITAL PEDI TRANSPORT
Street	3006 W DR MARTIN LUTHER KING JR BLVD MS 3032
City	TAMPA
State	FL
ZIP	33607
Phone	813 870-4226
CertificateType	4
CertificateEffectiveDate	12/27/2022
CertificateExpirationDate	12/26/2024
FacilityType	Waiver

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