10D2182859 CLIA NUMBER - FANTASTIC WOUND CARE INC

Laboratory Demographics

CLIA Number: 10D2182859

Facility Name: FANTASTIC WOUND CARE INC

Facility Address:
2580 METROCENTRE BLVD STE 6
WEST PALM BEACH, FL
ZIP 33407
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Facility Phone Number: 561 725-4100

Facility Type: Ancillary Testing Site in Health Care Center

Certificate Type: Waiver

NPI Number: 1457830804

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	10D2182859
LAB Type	Ancillary Testing Site in Health Care Center
Facility Name	FANTASTIC WOUND CARE INC
Street	2580 METROCENTRE BLVD STE 6
City	WEST PALM BEACH
State	FL
ZIP	33407
Phone	561 725-4100
CertificateType	4
CertificateEffectiveDate	4/27/2024
CertificateExpirationDate	4/26/2026
FacilityType	Waiver

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