10D0966520 CLIA NUMBER - NORTHEAST FLORIDA PLASTIC SURGERY CENTER LLC

Laboratory Demographics

  • CLIA Code: 10D0966520
  • Facility Name: NORTHEAST FLORIDA PLASTIC SURGERY CENTER LLC
  • Facility Address: 421 KINGLSEY AVE #200
    ORANGE PARK, FL
    ZIP 32073
  • Facility Phone: 904 215-5800
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ERIC A. WEISS
  • NPI Number: 1073745634
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 10D0966520
LAB Type Physician Office
Facility Name NORTHEAST FLORIDA PLASTIC SURGERY CENTER LLC
Street 421 KINGLSEY AVE #200
City ORANGE PARK
State FL
ZIP 32073
Phone 904 215-5800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/26/2023
Certificate Expiration Date 10/25/2025
Facility Type Physician Office
Lab Director ERIC A. WEISS

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