10D2202405 CLIA NUMBER - SOUTHERN VASCULAR OF PANAMA CITY

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Laboratory Demographics

CLIA Number: 10D2202405

Facility Name: SOUTHERN VASCULAR OF PANAMA CITY

Facility Address:
1399 JENKS AVE 12-J
PANAMA CITY, FL
ZIP 32401
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Facility Phone Number: 850 532-6303

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1699109181

Taxonomy: 2086S0129X - Surgery
A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.

CLIA Record

Field Name	Field Value
CLIA Number	10D2202405
LAB Type	Physician Office
Facility Name	SOUTHERN VASCULAR OF PANAMA CITY
Street	1399 JENKS AVE 12-J
City	PANAMA CITY
State	FL
ZIP	32401
Phone	850 532-6303
CertificateType	4
CertificateEffectiveDate	11/27/2022
CertificateExpirationDate	11/26/2024
FacilityType	Waiver

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