10D1084859 CLIA NUMBER - SURGICAL SPECIALISTS ASC

Laboratory Demographics

  • CLIA Code: 10D1084859
  • Facility Name: SURGICAL SPECIALISTS ASC
  • Facility Address: 1034 MAR WALT DRIVE SUITE 300
    FORT WALTON BEACH, FL
    ZIP 32547
  • Facility Phone: 850 863-5518
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: JASON W. THACKERAY
  • NPI Number: 1780871319
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D1084859
LAB Type Ambulatory Surgery Center
Facility Name SURGICAL SPECIALISTS ASC
Street 1034 MAR WALT DRIVE SUITE 300
City FORT WALTON BEACH
State FL
ZIP 32547
Phone 850 863-5518
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/5/2024
Certificate Expiration Date 6/4/2026
Facility Type Ambulatory Surgery Center
Lab Director JASON W. THACKERAY

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