10D2023049 CLIA NUMBER - PALM COAST OB GYN

Laboratory Demographics

  • CLIA Code: 10D2023049
  • Facility Name: PALM COAST OB GYN
  • Facility Address: 7 BOULDER ROCK DR STE 4
    PALM COAST, FL
    ZIP 32137
  • Facility Phone: 386 447-6831
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PATRICIA MODAD
  • NPI Number: 1942590401
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 10D2023049
LAB Type Physician Office
Facility Name PALM COAST OB GYN
Street 7 BOULDER ROCK DR STE 4
City PALM COAST
State FL
ZIP 32137
Phone 386 447-6831
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/2/2025
Certificate Expiration Date 6/1/2027
Facility Type Physician Office
Lab Director PATRICIA MODAD

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