10D2279137 CLIA NUMBER - AMAZING GRACE PRIMARY CARE LLC

Laboratory Demographics

  • CLIA Code: 10D2279137
  • Facility Name: AMAZING GRACE PRIMARY CARE LLC
  • Facility Address: 410 N MAIN STREET SUITE 11
    CHIEFLAND, FL
    ZIP 32626
  • Facility Phone: 352 949-0478
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SALLY MARTINEZ
  • NPI Number: 1821702663
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 10D2279137
LAB Type Physician Office
Facility Name AMAZING GRACE PRIMARY CARE LLC
Street 410 N MAIN STREET SUITE 11
City CHIEFLAND
State FL
ZIP 32626
Phone 352 949-0478
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/29/2025
Certificate Expiration Date 3/28/2027
Facility Type Physician Office
Lab Director SALLY MARTINEZ

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This page was last updated on: 9/29/2025