10D2176704 CLIA NUMBER - RADIOLOGY REGIONAL CENTER, P.A.

Laboratory Demographics

CLIA Number: 10D2176704

Facility Name: RADIOLOGY REGIONAL CENTER, P.A.

Facility Address:
18300 MURDOCK CIRCLE UNIT 101 BLD 15
PORT CHARLOTTE, FL
ZIP 33948
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Facility Phone Number: 239 936-2316

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1962178764

Taxonomy: 2085R0202X - Radiology
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

CLIA Record

Field Name	Field Value
CLIA Number	10D2176704
LAB Type	Practitioner Other
Facility Name	RADIOLOGY REGIONAL CENTER, P.A.
Street	18300 MURDOCK CIRCLE UNIT 101 BLD 15
City	PORT CHARLOTTE
State	FL
ZIP	33948
Phone	239 936-2316
CertificateType	4
CertificateEffectiveDate	12/20/2023
CertificateExpirationDate	12/19/2025
FacilityType	Waiver

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