10D2313746 CLIA NUMBER - CENTERWELL SENIOR PRIMARY CARE FL JV PLLC DBA CONVIVA SENIOR PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 10D2313746
  • Facility Name: CENTERWELL SENIOR PRIMARY CARE FL JV PLLC DBA CONVIVA SENIOR PRIMARY CARE
  • Facility Address: 4250 PHILLIPS HWY
    JACKSONVILLE, FL
    ZIP 32207
  • Facility Phone: 904 839-1018
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AHMED FARID
  • NPI Number: 1003643214
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D2313746
LAB Type Physician Office
Facility Name CENTERWELL SENIOR PRIMARY CARE FL JV PLLC DBA CONVIVA SENIOR PRIMARY CARE
Street 4250 PHILLIPS HWY
City JACKSONVILLE
State FL
ZIP 32207
Phone 904 839-1018
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/6/2024
Certificate Expiration Date 11/5/2026
Facility Type Physician Office
Lab Director AHMED FARID

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This page was last updated on: 3/20/2025