10D2304217 CLIA NUMBER - BAPTIST PRIMARY CARE INC

Laboratory Demographics

  • CLIA Code: 10D2304217
  • Facility Name: BAPTIST PRIMARY CARE INC
  • Facility Address: 2839 HENLEY ROAD
    GREEN COVE SPRINGS, FL
    ZIP 32043
  • Facility Phone: 904 376-4950
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SHIVA MAHINRAD
  • NPI Number: 1275398216
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D2304217
LAB Type Physician Office
Facility Name BAPTIST PRIMARY CARE INC
Street 2839 HENLEY ROAD
City GREEN COVE SPRINGS
State FL
ZIP 32043
Phone 904 376-4950
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/9/2024
Certificate Expiration Date 5/8/2026
Facility Type Physician Office
Lab Director SHIVA MAHINRAD

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