10D2167072 CLIA NUMBER - GEARITY WELLNESS CENTER LLC

Laboratory Demographics

CLIA Number: 10D2167072

Facility Name: GEARITY WELLNESS CENTER LLC

Facility Address:
2914 17TH STREET
SAINT CLOUD, FL
ZIP 34769
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Facility Phone Number: 407 418-9122

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1497323125

Taxonomy: 207QA0505X - Family Medicine
The National Uniform Claim Committee (NUCC) recommends code 207QA0505X not be used. Choose a more appropriate code.

CLIA Record

Field Name	Field Value
CLIA Number	10D2167072
LAB Type	Physician Office
Facility Name	GEARITY WELLNESS CENTER LLC
Street	2914 17TH STREET
City	SAINT CLOUD
State	FL
ZIP	34769
Phone	407 418-9122
CertificateType	4
CertificateEffectiveDate	5/31/2023
CertificateExpirationDate	5/30/2025
FacilityType	Waiver

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