10D2206764 CLIA NUMBER - TOTAL MD CARE

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Laboratory Demographics

CLIA Number: 10D2206764

Facility Name: TOTAL MD CARE

Facility Address:
4340 S HOPKINS AVE
TITUSVILLE, FL
ZIP 32780
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Facility Phone Number: 321 222-3607

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1972071868

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2206764
LAB Type	Physician Office
Facility Name	TOTAL MD CARE
Street	4340 S HOPKINS AVE
City	TITUSVILLE
State	FL
ZIP	32780
Phone	321 222-3607
CertificateType	4
CertificateEffectiveDate	12/22/2022
CertificateExpirationDate	12/21/2024
FacilityType	Waiver

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