10D2224663 CLIA NUMBER - ULTIMATE MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 10D2224663
  • Facility Name: ULTIMATE MEDICAL CLINIC
  • Facility Address: 70 FOX RIDGE CT STE A
    DEBARY, FL
    ZIP 32713
  • Facility Phone: 386 668-6321
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LAUREN A. EGGNATZ
  • NPI Number: 1922692003
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D2224663
LAB Type Physician Office
Facility Name ULTIMATE MEDICAL CLINIC
Street 70 FOX RIDGE CT STE A
City DEBARY
State FL
ZIP 32713
Phone 386 668-6321
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/14/2025
Certificate Expiration Date 5/13/2027
Facility Type Physician Office
Lab Director LAUREN A. EGGNATZ

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This page was last updated on: 6/4/2025