10D2236240 CLIA NUMBER - HOLY CROSS MEDICAL CENTER, LLC DBA DACONA MEDICAL CENTER

Laboratory Demographics

CLIA Number: 10D2236240

Facility Name: HOLY CROSS MEDICAL CENTER, LLC DBA DACONA MEDICAL CENTER

Facility Address:
4109 N ARMENIA AVE STE A
TAMPA, FL
ZIP 33607
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Facility Phone Number: 813 588-3842

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1174118608

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2236240
LAB Type	Physician Office
Facility Name	HOLY CROSS MEDICAL CENTER, LLC DBA DACONA MEDICAL CENTER
Street	4109 N ARMENIA AVE STE A
City	TAMPA
State	FL
ZIP	33607
Phone	813 588-3842
CertificateType	4
CertificateEffectiveDate	9/15/2023
CertificateExpirationDate	9/14/2025
FacilityType	Waiver

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