10D2245206 CLIA NUMBER - IMC FL LLC

Laboratory Demographics

CLIA Number: 10D2245206

Facility Name: IMC FL LLC

Facility Address:
9918 GULF COAST MAIN STEET STE 100
FORT MYERS, FL
ZIP 33913
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Facility Phone Number: 239 846-9362

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1982353934

Taxonomy: 261QH0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2245206
LAB Type	Physician Office
Facility Name	IMC FL LLC
Street	9918 GULF COAST MAIN STEET STE 100
City	FORT MYERS
State	FL
ZIP	33913
Phone	239 846-9362
CertificateType	4
CertificateEffectiveDate	12/9/2023
CertificateExpirationDate	12/8/2025
FacilityType	Waiver

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