10D2226567 CLIA NUMBER - DAWSON INTEGRATIVE MEDICAL CENTER LLC

Laboratory Demographics

CLIA Number: 10D2226567

Facility Name: DAWSON INTEGRATIVE MEDICAL CENTER LLC

Facility Address:
10244 E COLONIAL AVENUE SUITE 204
ORLANDO, FL
ZIP 32817
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Facility Phone Number: 407 777-2673

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1679152979

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2226567
LAB Type	Physician Office
Facility Name	DAWSON INTEGRATIVE MEDICAL CENTER LLC
Street	10244 E COLONIAL AVENUE SUITE 204
City	ORLANDO
State	FL
ZIP	32817
Phone	407 777-2673
CertificateType	4
CertificateEffectiveDate	6/2/2023
CertificateExpirationDate	6/1/2025
FacilityType	Waiver

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