10D2074824 CLIA NUMBER - PHYSICIANS GROUP SERVICES PA DBA COASTAL SPINE AND PAIN CENTER RIVERSIDE

Laboratory Demographics

  • CLIA Code: 10D2074824
  • Facility Name: PHYSICIANS GROUP SERVICES PA DBA COASTAL SPINE AND PAIN CENTER RIVERSIDE
  • Facility Address: 2700 RIVERSIDE AVE
    JACKSONVILLE, FL
    ZIP 32205
  • Facility Phone: 904 265-4343
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KENNETH POWELL
  • NPI Number: 1952706368
  • Taxonomy: 208100000X - Physical Medicine & Rehabilitation

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CLIA Record

Field Name Field Value
CLIA Number 10D2074824
LAB Type Physician Office
Facility Name PHYSICIANS GROUP SERVICES PA DBA COASTAL SPINE AND PAIN CENTER RIVERSIDE
Street 2700 RIVERSIDE AVE
City JACKSONVILLE
State FL
ZIP 32205
Phone 904 265-4343
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/17/2024
Certificate Expiration Date 3/16/2026
Facility Type Physician Office
Lab Director KENNETH POWELL

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