CIVIS - Florida Department of Health€¦ · Division of LaboratoryServices Survey and...
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0 V I I ' & CENTERS FOR MEDICARE & MEDICAID SERVICES CLINICAL LABORATORY IMPROVEMENT AMENDMENTS CERTIFICA TE OF COMPLIANCE I I CLIA ID NUMBER 10 D 0645348 LABORATORY NAME AND ADDRESS FDOH BUREAU OF PUBLIC HEALTH LABORATOR 1325 NW 14 TH AVE MIAMI , FL 33125 EFFECTIVE DATE 10 / 14 / 2019 EXPIRATION DATE LABORATORY DIRECTOR 10/13 /2021 ANDREW C CANNONS Ph .D. Pursuant to Section 353 of the Public Health Services Act ( 42 U. S . C . 263 a ) as revised by the Clinical laboratory Improvement Amendments ( CLIA ), the above named laboratory located at the address shown hereon ( and other approved locations ) may accept human specimens for the purposes of performing laboratory examinations or procedures . This certificate shall be valid until the expiration date above , but is subject to revocation , suspension , limitation , or other sanctions for violation of the Act or the regulations promulgated thereunder . i i i 9 , Karen W . Dyer , Director Division of Laboratory Services Survey and Certification Group Center for Clinical Standards and Quality CIVIS CENTERS FOR MEDICARE & MEDICAID SERVICES I 0 % 73 certs 2 102919 If you currently hold a Certificate of Compliance or Certificate of Accreditation , below is a list of the laboratory specialties / subspecialties you are certified to perform and their effective date: LAB CERTIFICATION ( CODE ) BACTERIOLOGY ( 110 ) PARASITOLOGY ( 130 ) VIROLOGY ( 140) SYPHILIS SEROLOGY ( 210 ) GENERAL IMMUNOLOGY ( 220 ) EFFECTIVE DATE LAB CERTIFICATION ( CODE ) EFFECTIVE DATE 10 / 14/ 1993 10/ 14/ 1993 07/28/ 2016 10/ 14/1993 10/ 14 / 1993 FOR MORE INFORMATION ABOUT CLIA , VISIT OUR WEBSITE AT WWW . CMS. GOV/ CLIA OR CONTACT YOUR LOCAL STATE AGENCY . PLEASE SEE THE REVERSE FOR YOUR STATE AGENCY ’ S ADDRESS AND PHONE NUMBER . PLEASE CONTACT YOUR STATE AGENCY FOR ANY CHANGES TO YOUR CURRENT CERTIFICATE.
Transcript of CIVIS - Florida Department of Health€¦ · Division of LaboratoryServices Survey and...
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I'& CENTERS FOR MEDICARE & MEDICAID SERVICESCLINICAL LABORATORY IMPROVEMENT AMENDMENTS
CERTIFICATE OF COMPLIANCE II CLIA ID NUMBER10D0645348
LABORATORY NAME AND ADDRESSFDOH BUREAU OF PUBLIC HEALTH LABORATOR1325 NW 14TH AVEMIAMI, FL 33125 EFFECTIVE DATE
10/14/2019
EXPIRATION DATELABORATORY DIRECTOR
10/13/2021ANDREW C CANNONS Ph.D.
Pursuant to Section 353 of the Public Health Services Act (42 U.S.C. 263a) as revised by the Clinical laboratory Improvement Amendments (CLIA),the above named laboratory located at the address shown hereon (and other approved locations) may accept human specimens
for the purposes of performing laboratory examinations or procedures.This certificate shall be valid until the expiration date above, but is subject to revocation, suspension, limitation, or other sanctions
for violation of the Act or the regulations promulgated thereunder. ii i9, Karen W. Dyer, DirectorDivision of Laboratory ServicesSurvey and Certification GroupCenter for Clinical Standards and QualityCIVIS
CENTERS FOR MEDICARE & MEDICAID SERVICES
I
0 %73 certs2 102919
If you currently hold a Certificate of Compliance or Certificate of Accreditation, below is a list of the laboratoryspecialties/subspecialties you are certified to perform and their effective date:
LAB CERTIFICATION (CODE)
BACTERIOLOGY (110)
PARASITOLOGY (130)
VIROLOGY (140)
SYPHILIS SEROLOGY (210)
GENERAL IMMUNOLOGY (220)
EFFECTIVE DATE LAB CERTIFICATION (CODE) EFFECTIVE DATE10/14/199310/14/199307/28/201610/14/199310/14/1993
FOR MORE INFORMATION ABOUT CLIA, VISIT OUR WEBSITE AT WWW.CMS.GOV/CLIAOR CONTACT YOUR LOCAL STATE AGENCY. PLEASE SEE THE REVERSE FOR
YOUR STATE AGENCY’S ADDRESS AND PHONE NUMBER.PLEASE CONTACT YOUR STATE AGENCY FOR ANY CHANGES TO YOUR CURRENT CERTIFICATE.
CLIA ID Number: 10D0645348FDOH BUREAU OF PUBLIC HEALTH LABORATOR1325 NW 14TH AVEMIAMI, FL 33125
STATE AGENCY ADDRESS AND PHONE NUMBER:
STATE OF FL/AGENCY FOR HEALTH CARE ADMINLABORATORY LICENSING UNIT2727 MAHAN DR, MAIL STOP 32TALLAHASSEE, FL 32308(850)412-4500
LABORATORY MAILING ADDRESS:
