10D2173551 CLIA NUMBER - WIREGRASS DIRECT PRIMARY CARE PLLC

Laboratory Demographics

  • CLIA Code: 10D2173551
  • Facility Name: WIREGRASS DIRECT PRIMARY CARE PLLC
  • Facility Address: 2236 GREEN HEDGES WAY
    WESLEY CHAPEL, FL
    ZIP 33544
  • Facility Phone: 813 999-0505
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: MICHAEL D. IPOCK
  • NPI Number: 1649827577
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D2173551
LAB Type Practitioner Other
Facility Name WIREGRASS DIRECT PRIMARY CARE PLLC
Street 2236 GREEN HEDGES WAY
City WESLEY CHAPEL
State FL
ZIP 33544
Phone 813 999-0505
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/15/2025
Certificate Expiration Date 10/14/2027
Facility Type Practitioner Other
Lab Director MICHAEL D. IPOCK

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