10D2212190 CLIA NUMBER - DIS OF TAMPA BAY INC DBA NEW VISTA DIAGNOSTIC OF FOUNTAIN OAKS

Laboratory Demographics

CLIA Number: 10D2212190

Facility Name: DIS OF TAMPA BAY INC DBA NEW VISTA DIAGNOSTIC OF FOUNTAIN OAKS

Facility Address:
3635 W WATERS AVE
TAMPA, FL
ZIP 33614
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Facility Phone Number: 813 724-3310

Facility Type: Other - DIAGNOSTIC IMAGING

Certificate Type: Waiver

NPI Number: 1609422146

Taxonomy: 261QR0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2212190
LAB Type	Other - DIAGNOSTIC IMAGING
Facility Name	DIS OF TAMPA BAY INC DBA NEW VISTA DIAGNOSTIC OF FOUNTAIN OAKS
Street	3635 W WATERS AVE
City	TAMPA
State	FL
ZIP	33614
Phone	813 724-3310
CertificateType	4
CertificateEffectiveDate	2/3/2023
CertificateExpirationDate	2/2/2025
FacilityType	Waiver

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