10D2182880 CLIA NUMBER - MAIN STREET MEDICAL CENTERS

Laboratory Demographics

CLIA Number: 10D2182880

Facility Name: MAIN STREET MEDICAL CENTERS

Facility Address:
10549 N FLORIDA AVE STE I
TAMPA, FL
ZIP 33612
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Facility Phone Number: 813 220-1400

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1487079505

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2182880
LAB Type	Physician Office
Facility Name	MAIN STREET MEDICAL CENTERS
Street	10549 N FLORIDA AVE STE I
City	TAMPA
State	FL
ZIP	33612
Phone	813 220-1400
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