10D2275931 CLIA NUMBER - ADVENTHEALTH IMAGING CENTER BLOOMINGDALE

Laboratory Demographics

CLIA Number: 10D2275931

Facility Name: ADVENTHEALTH IMAGING CENTER BLOOMINGDALE

Facility Address:
13403 BOYETTE RD
RIVERVIEW, FL
ZIP 33569
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Facility Phone Number: 813 467-4293

Facility Type: Other - IDTF

Certificate Type: Waiver

NPI Number: 1760199517

Taxonomy: 261QR0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2275931
LAB Type	Other - IDTF
Facility Name	ADVENTHEALTH IMAGING CENTER BLOOMINGDALE
Street	13403 BOYETTE RD
City	RIVERVIEW
State	FL
ZIP	33569
Phone	813 467-4293
CertificateType	4
CertificateEffectiveDate	1/31/2023
CertificateExpirationDate	1/30/2025
FacilityType	Waiver

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