10D2190398 CLIA NUMBER - OURHEALTH PROFESSIONAL PHYSICIAN GROUP LLC

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Laboratory Demographics

CLIA Number: 10D2190398

Facility Name: OURHEALTH PROFESSIONAL PHYSICIAN GROUP LLC

Facility Address:
6277 SEA HARBOR DRIVE
ORLANDO, FL
ZIP 32821
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Facility Phone Number: 689 210-0525

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1740804566

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	10D2190398
LAB Type	Physician Office
Facility Name	OURHEALTH PROFESSIONAL PHYSICIAN GROUP LLC
Street	6277 SEA HARBOR DRIVE
City	ORLANDO
State	FL
ZIP	32821
Phone	689 210-0525
CertificateType	4
CertificateEffectiveDate	8/13/2022
CertificateExpirationDate	8/12/2024
FacilityType	Waiver

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