10D1074662 CLIA NUMBER - ST AUGUSTINE ENDOSCOPY CENTER LLC

Laboratory Demographics

  • CLIA Code: 10D1074662
  • Facility Name: ST AUGUSTINE ENDOSCOPY CENTER LLC
  • Facility Address: 40 GROOVER LOOP STE 100
    SAINT AUGUSTINE, FL
    ZIP 32086
  • Facility Phone: 904 824-6108
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: ANIS AHMADI
  • NPI Number: 1841251501
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D1074662
LAB Type Ambulatory Surgery Center
Facility Name ST AUGUSTINE ENDOSCOPY CENTER LLC
Street 40 GROOVER LOOP STE 100
City SAINT AUGUSTINE
State FL
ZIP 32086
Phone 904 824-6108
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/3/2025
Certificate Expiration Date 10/2/2027
Facility Type Ambulatory Surgery Center
Lab Director ANIS AHMADI

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