10D2189761 CLIA NUMBER - BAPTIST PRIMARY CARE INC

Laboratory Demographics

  • CLIA Code: 10D2189761
  • Facility Name: BAPTIST PRIMARY CARE INC
  • Facility Address: 462626 STATE ROAD 200 SUITE 100
    YULEE, FL
    ZIP 32097
  • Facility Phone: 904 255-3824
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ERICA WIEDL
  • NPI Number: 1710509203
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D2189761
LAB Type Physician Office
Facility Name BAPTIST PRIMARY CARE INC
Street 462626 STATE ROAD 200 SUITE 100
City YULEE
State FL
ZIP 32097
Phone 904 255-3824
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/5/2024
Certificate Expiration Date 8/4/2026
Facility Type Physician Office
Lab Director ERICA WIEDL

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This page was last updated on: 6/4/2025