10D2165980 CLIA NUMBER - OLYMPIA MEDICAL GROUP, LLC

Laboratory Demographics

  • CLIA Code: 10D2165980
  • Facility Name: OLYMPIA MEDICAL GROUP, LLC
  • Facility Address: 2306 NORTH BLVD W, SUITE C
    DAVENPORT, FL
    ZIP 33837
  • Facility Phone: 863 547-9200
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: HERNAN III LUGO OLIVIERI
  • NPI Number: 1013473495
  • Taxonomy: 207Q00000X - Family Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 10D2165980
LAB Type Physician Office
Facility Name OLYMPIA MEDICAL GROUP, LLC
Street 2306 NORTH BLVD W, SUITE C
City DAVENPORT
State FL
ZIP 33837
Phone 863 547-9200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/9/2025
Certificate Expiration Date 5/8/2027
Facility Type Physician Office
Lab Director HERNAN III LUGO OLIVIERI

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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