10D2057773 CLIA NUMBER - PHYSICIANS GROUP SERVICES PA DBA COASTAL SPINE AND PAIN CENTER

Laboratory Demographics

  • CLIA Code: 10D2057773
  • Facility Name: PHYSICIANS GROUP SERVICES PA DBA COASTAL SPINE AND PAIN CENTER
  • Facility Address: 280 DUNDAS DR
    JACKSONVILLE, FL
    ZIP 32218
  • Facility Phone: 904 751-4906
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KENNETH POWELL
  • NPI Number: 1831530658
  • Taxonomy: 208VP0000X - Pain Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D2057773
LAB Type Physician Office
Facility Name PHYSICIANS GROUP SERVICES PA DBA COASTAL SPINE AND PAIN CENTER
Street 280 DUNDAS DR
City JACKSONVILLE
State FL
ZIP 32218
Phone 904 751-4906
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/23/2025
Certificate Expiration Date 4/22/2027
Facility Type Physician Office
Lab Director KENNETH POWELL

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