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10D1008025 CLIA NUMBER - ATLANTIC SURGERY CENTER OF JACKSONVILLE BEACH

Laboratory Demographics

CLIA Number: 10D1008025

Facility Name: ATLANTIC SURGERY CENTER OF JACKSONVILLE BEACH

Facility Address:
1361 13TH AVE SOUTH SUITES 125 & 130
JACKSONVILLE, FL
ZIP 32250
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Facility Phone Number: 904 249-2580

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1336208081

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name Field Value
CLIA Number 10D1008025
LAB Type Physician Office
Facility Name ATLANTIC SURGERY CENTER OF JACKSONVILLE BEACH
Street 1361 13TH AVE SOUTH SUITES 125 & 130
City JACKSONVILLE
State FL
ZIP 32250
Phone 904 249-2580
CertificateType 4
CertificateEffectiveDate 1/8/2023
CertificateExpirationDate 1/7/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024