10D2161709 CLIA NUMBER - MID FLORIDA PHYSICIANS GROUP

Laboratory Demographics

  • CLIA Code: 10D2161709
  • Facility Name: MID FLORIDA PHYSICIANS GROUP
  • Facility Address: 300 S MAIN ST STE 2
    WILDWOOD, FL
    ZIP 34785
  • Facility Phone: 352 643-6699
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JERROLD R. ECKLIND
  • NPI Number: 1629565932
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D2161709
LAB Type Physician Office
Facility Name MID FLORIDA PHYSICIANS GROUP
Street 300 S MAIN ST STE 2
City WILDWOOD
State FL
ZIP 34785
Phone 352 643-6699
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/8/2025
Certificate Expiration Date 2/7/2027
Facility Type Physician Office
Lab Director JERROLD R. ECKLIND

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This page was last updated on: 9/29/2025