10D2254086 CLIA NUMBER - LAKESIDE CLINIC LLC DBA MEDMARK TREATMENT CENTERS CLEARWATER

Laboratory Demographics

CLIA Number: 10D2254086

Facility Name: LAKESIDE CLINIC LLC DBA MEDMARK TREATMENT CENTERS CLEARWATER

Facility Address:
13700 58TH STREET N
CLEARWATER, FL
ZIP 33760
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Facility Phone Number: 727 223-3545

Facility Type: Other - NARCOTIC TREATMENT PROGRA

Certificate Type: Waiver

NPI Number: 1992162879

Taxonomy: 261QM2800X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction.

CLIA Record

Field Name	Field Value
CLIA Number	10D2254086
LAB Type	Other - NARCOTIC TREATMENT PROGRA
Facility Name	LAKESIDE CLINIC LLC DBA MEDMARK TREATMENT CENTERS CLEARWATER
Street	13700 58TH STREET N
City	CLEARWATER
State	FL
ZIP	33760
Phone	727 223-3545
CertificateType	4
CertificateEffectiveDate	2/29/2024
CertificateExpirationDate	2/27/2026
FacilityType	Waiver

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