10D2214322 CLIA NUMBER - FLORIDA CONCIERGE MEDICINE & WELLNESS

Laboratory Demographics

CLIA Number: 10D2214322

Facility Name: FLORIDA CONCIERGE MEDICINE & WELLNESS

Facility Address:
5555 HOLLYWOOD BLVD STE 201
HOLLYWOOD, FL
ZIP 33021
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Facility Phone Number: 954 932-3269

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1013585868

Taxonomy: 261QM2500X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).

CLIA Record

Field Name	Field Value
CLIA Number	10D2214322
LAB Type	Physician Office
Facility Name	FLORIDA CONCIERGE MEDICINE & WELLNESS
Street	5555 HOLLYWOOD BLVD STE 201
City	HOLLYWOOD
State	FL
ZIP	33021
Phone	954 932-3269
CertificateType	4
CertificateEffectiveDate	2/22/2023
CertificateExpirationDate	2/21/2025
FacilityType	Waiver

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