01D2109847 CLIA NUMBER - EASTERN SHORE COSMETIC SURGERY

Laboratory Demographics

  • CLIA Code: 01D2109847
  • Facility Name: EASTERN SHORE COSMETIC SURGERY
  • Facility Address: 7541 CIPRIANO COURT
    FAIRHOPE, AL
    ZIP 36532
  • Facility Phone: 251 929-7850
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: JAMES R. KOEHLER MD
  • NPI Number: 1699068783
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 01D2109847
LAB Type Ambulatory Surgery Center
Facility Name EASTERN SHORE COSMETIC SURGERY
Street 7541 CIPRIANO COURT
City FAIRHOPE
State AL
ZIP 36532
Phone 251 929-7850
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/3/2024
Certificate Expiration Date 3/2/2026
Facility Type Ambulatory Surgery Center
Lab Director JAMES R. KOEHLER MD

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