10D2168974 CLIA NUMBER - SPACE COAST NEPHROLOGY ASSOCIATES, PLLC

Laboratory Demographics

CLIA Number: 10D2168974

Facility Name: SPACE COAST NEPHROLOGY ASSOCIATES, PLLC

Facility Address:
14 SUNTREE PLACE SUITE 104
MELBOURNE, FL
ZIP 32940
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Facility Phone Number: 321 837-9015

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1841472479

Taxonomy: 213ES0103X - Podiatrist

CLIA Record

Field Name	Field Value
CLIA Number	10D2168974
LAB Type	Physician Office
Facility Name	SPACE COAST NEPHROLOGY ASSOCIATES, PLLC
Street	14 SUNTREE PLACE SUITE 104
City	MELBOURNE
State	FL
ZIP	32940
Phone	321 837-9015
CertificateType	4
CertificateEffectiveDate	7/12/2023
CertificateExpirationDate	7/11/2025
FacilityType	Waiver

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