10D2291279 CLIA NUMBER - COMMUNITY HOSPITAL FAMILY PRACTICE, LLC

Laboratory Demographics

CLIA Number: 10D2291279

Facility Name: COMMUNITY HOSPITAL FAMILY PRACTICE, LLC

Facility Address:
13740 OFFICE PARK COURT, SUITE B
HUDSON, FL
ZIP 34667
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Facility Phone Number: 727 619-0900

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1215338751

Taxonomy: 261QA0600X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2291279
LAB Type	Physician Office
Facility Name	COMMUNITY HOSPITAL FAMILY PRACTICE, LLC
Street	13740 OFFICE PARK COURT, SUITE B
City	HUDSON
State	FL
ZIP	34667
Phone	727 619-0900
CertificateType	4
CertificateEffectiveDate	10/9/2023
CertificateExpirationDate	10/8/2025
FacilityType	Waiver

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