10D2228608 CLIA NUMBER - IMPACT MEDGROUP INC

Laboratory Demographics

  • CLIA Code: 10D2228608
  • Facility Name: IMPACT MEDGROUP INC
  • Facility Address: 724 39TH ST W
    BRADENTON, FL
    ZIP 34205
  • Facility Phone: 941 303-0555
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AL WILLIAM ROBAINA
  • NPI Number: 1427371921
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D2228608
LAB Type Physician Office
Facility Name IMPACT MEDGROUP INC
Street 724 39TH ST W
City BRADENTON
State FL
ZIP 34205
Phone 941 303-0555
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/29/2025
Certificate Expiration Date 6/28/2027
Facility Type Physician Office
Lab Director AL WILLIAM ROBAINA

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This page was last updated on: 9/29/2025