10D2301227 CLIA NUMBER - PROSPERITY FAMILY MEDICAL GROUP CORP

Laboratory Demographics

CLIA Number: 10D2301227

Facility Name: PROSPERITY FAMILY MEDICAL GROUP CORP

Facility Address:
11380 VPROSPERITY FARMS RD STE215
PALM BEACH GARDENS, FL
ZIP 33410
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Facility Phone Number: 561 794-0456

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1932883774

Taxonomy: 207QA0505X - Family Medicine
The National Uniform Claim Committee (NUCC) recommends code 207QA0505X not be used. Choose a more appropriate code.

CLIA Record

Field Name	Field Value
CLIA Number	10D2301227
LAB Type	Physician Office
Facility Name	PROSPERITY FAMILY MEDICAL GROUP CORP
Street	11380 VPROSPERITY FARMS RD STE215
City	PALM BEACH GARDENS
State	FL
ZIP	33410
Phone	561 794-0456
CertificateType	4
CertificateEffectiveDate	3/22/2024
CertificateExpirationDate	3/21/2026
FacilityType	Waiver

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