10D2211416 CLIA NUMBER - INDEPENDENT MEDICAL GROUP LLC

Laboratory Demographics

CLIA Number: 10D2211416

Facility Name: INDEPENDENT MEDICAL GROUP LLC

Facility Address:
28420 BONITA CROSSINGS BLVD SUITE #130
BONITA SPRINGS, FL
ZIP 34135
Get Directions

Facility Phone Number: 734 478-7842

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1790376945

Taxonomy: 261QH0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2211416
LAB Type	Physician Office
Facility Name	INDEPENDENT MEDICAL GROUP LLC
Street	28420 BONITA CROSSINGS BLVD SUITE #130
City	BONITA SPRINGS
State	FL
ZIP	34135
Phone	734 478-7842
CertificateType	4
CertificateEffectiveDate	1/27/2023
CertificateExpirationDate	1/26/2025
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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