10D2264411 CLIA NUMBER - DEDICATED SENIOR MEDICAL CENTER LEALMAN

Laboratory Demographics

CLIA Number: 10D2264411

Facility Name: DEDICATED SENIOR MEDICAL CENTER LEALMAN

Facility Address:
2805 54TH AVE N - STE 500
SAINT PETERSBURG, FL
ZIP 33705
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Facility Phone Number: 727 341-5800

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1710649769

Taxonomy: 332900000X - Non-Pharmacy Dispensing Site
A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)

CLIA Record

Field Name	Field Value
CLIA Number	10D2264411
LAB Type	Physician Office
Facility Name	DEDICATED SENIOR MEDICAL CENTER LEALMAN
Street	2805 54TH AVE N - STE 500
City	SAINT PETERSBURG
State	FL
ZIP	33705
Phone	727 341-5800
CertificateType	4
CertificateEffectiveDate	7/14/2022
CertificateExpirationDate	7/13/2024
FacilityType	Waiver

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