10D2161048 CLIA NUMBER - SIMONMED IMAGING FLORIDA LLC DBA SIMONMED IMAGING PORT CHARLOTTE

Laboratory Demographics

CLIA Number: 10D2161048

Facility Name: SIMONMED IMAGING FLORIDA LLC DBA SIMONMED IMAGING PORT CHARLOTTE

Facility Address:
4161 TAMIAMI TRAIL BLDG 2 STE 204
PORT CHARLOTTE, FL
ZIP 33952
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Facility Phone Number: 602 688-6116

Facility Type: Other - OUTPATIENT MEDICAL IMAGIN

Certificate Type: Waiver

NPI Number: 1811567894

Taxonomy: 2085R0202X - Radiology
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

CLIA Record

Field Name	Field Value
CLIA Number	10D2161048
LAB Type	Other - OUTPATIENT MEDICAL IMAGIN
Facility Name	SIMONMED IMAGING FLORIDA LLC DBA SIMONMED IMAGING PORT CHARLOTTE
Street	4161 TAMIAMI TRAIL BLDG 2 STE 204
City	PORT CHARLOTTE
State	FL
ZIP	33952
Phone	602 688-6116
CertificateType	4
CertificateEffectiveDate	1/24/2023
CertificateExpirationDate	1/23/2025
FacilityType	Waiver

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