10D2282176 CLIA NUMBER - BAPTIST MD ANDERSON CANCER PHYSICIANS, INC

Laboratory Demographics

CLIA Number: 10D2282176

Facility Name: BAPTIST MD ANDERSON CANCER PHYSICIANS, INC

Facility Address:
2310 VILLAGE SQUARE PKWY, SUITE 106
FLEMING ISLAND, FL
ZIP 32003
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Facility Phone Number: 904 202-7397

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1578805875

Taxonomy: 207RC0000X - Internal Medicine
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.

CLIA Record

Field Name	Field Value
CLIA Number	10D2282176
LAB Type	Physician Office
Facility Name	BAPTIST MD ANDERSON CANCER PHYSICIANS, INC
Street	2310 VILLAGE SQUARE PKWY, SUITE 106
City	FLEMING ISLAND
State	FL
ZIP	32003
Phone	904 202-7397
CertificateType	4
CertificateEffectiveDate	5/17/2023
CertificateExpirationDate	5/16/2025
FacilityType	Waiver

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