10D2171387 CLIA NUMBER - TRI-COUNTY HEART INSTITUTE PA

Laboratory Demographics

CLIA Number: 10D2171387

Facility Name: TRI-COUNTY HEART INSTITUTE PA

Facility Address:
26218 US HWY 27 SUITE 103
LEESBURG, FL
ZIP 34748
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Facility Phone Number: 352 504-3500

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1063967149

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	10D2171387
LAB Type	Physician Office
Facility Name	TRI-COUNTY HEART INSTITUTE PA
Street	26218 US HWY 27 SUITE 103
City	LEESBURG
State	FL
ZIP	34748
Phone	352 504-3500
CertificateType	4
CertificateEffectiveDate	8/29/2023
CertificateExpirationDate	8/28/2025
FacilityType	Waiver

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