10D0999175 CLIA NUMBER - SOUTH LAKE OB-GYN

Laboratory Demographics

  • CLIA Code: 10D0999175
  • Facility Name: SOUTH LAKE OB-GYN
  • Facility Address: 1900 DON WICKHAM DR SUITE 120
    CLERMONT, FL
    ZIP 34711
  • Facility Phone: 352 241-7050
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: MATTHEW S. CASAVANT
  • NPI Number: 1497754121
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 10D0999175
LAB Type Physician Office
Facility Name SOUTH LAKE OB-GYN
Street 1900 DON WICKHAM DR SUITE 120
City CLERMONT
State FL
ZIP 34711
Phone 352 241-7050
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 3/14/2025
Certificate Expiration Date 3/13/2027
Facility Type Physician Office
Lab Director MATTHEW S. CASAVANT

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