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10D2260456 CLIA NUMBER - DYNAMIC PRIMARY HEALTHCARE CLINIC INC

Laboratory Demographics

CLIA Number: 10D2260456

Facility Name: DYNAMIC PRIMARY HEALTHCARE CLINIC INC

Facility Address:
163 STONEGATE TERRACE SUITE 109
LAKE CITY, FL
ZIP 32024
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Facility Phone Number: 386 438-8391

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1710633144

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name Field Value
CLIA Number 10D2260456
LAB Type Physician Office
Facility Name DYNAMIC PRIMARY HEALTHCARE CLINIC INC
Street 163 STONEGATE TERRACE SUITE 109
City LAKE CITY
State FL
ZIP 32024
Phone 386 438-8391
CertificateType 4
CertificateEffectiveDate 5/19/2022
CertificateExpirationDate 5/18/2024
FacilityType Waiver

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