10D2161545 CLIA NUMBER - SIMONMED IMAGING FLORIDA LLC DBA SIMONMED IMAGING - ST PETERSBURG

Laboratory Demographics

CLIA Number: 10D2161545

Facility Name: SIMONMED IMAGING FLORIDA LLC DBA SIMONMED IMAGING - ST PETERSBURG

Facility Address:
840 DR MLK JR ST NORTH - STE 100
SAINT PETERSBURG, FL
ZIP 33705
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Facility Phone Number: 727 440-8250

Facility Type: Other - OUTPATIENT MED IMAGING

Certificate Type: Waiver

NPI Number: 1538739479

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	10D2161545
LAB Type	Other - OUTPATIENT MED IMAGING
Facility Name	SIMONMED IMAGING FLORIDA LLC DBA SIMONMED IMAGING - ST PETERSBURG
Street	840 DR MLK JR ST NORTH - STE 100
City	SAINT PETERSBURG
State	FL
ZIP	33705
Phone	727 440-8250
CertificateType	4
CertificateEffectiveDate	2/5/2023
CertificateExpirationDate	2/4/2025
FacilityType	Waiver

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