10D1012524 CLIA NUMBER - INTERCOASTAL MEDICAL GROUP AMBULATORY SURGERY CTR

Laboratory Demographics

  • CLIA Code: 10D1012524
  • Facility Name: INTERCOASTAL MEDICAL GROUP AMBULATORY SURGERY CTR
  • Facility Address: 3333 CATTLEMAN RD #100
    SARASOTA, FL
    ZIP 34232
  • Facility Phone: 941 379-5884
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: STACIE DILLER
  • NPI Number: 1801869847
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D1012524
LAB Type Ambulatory Surgery Center
Facility Name INTERCOASTAL MEDICAL GROUP AMBULATORY SURGERY CTR
Street 3333 CATTLEMAN RD #100
City SARASOTA
State FL
ZIP 34232
Phone 941 379-5884
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/13/2025
Certificate Expiration Date 5/12/2027
Facility Type Ambulatory Surgery Center
Lab Director STACIE DILLER

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