10D2074917 CLIA NUMBER - COASTAL ANESTHESIA PA PAIN MGMT CLINIC

Laboratory Demographics

  • CLIA Code: 10D2074917
  • Facility Name: COASTAL ANESTHESIA PA PAIN MGMT CLINIC
  • Facility Address: 1001 W COLLEGE BLVD STE H BLDG 2
    NICEVILLE, FL
    ZIP 32578
  • Facility Phone: 850 279-4417
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL P. EDERER
  • NPI Number: 1932205606
  • Taxonomy: 207LP2900X - Anesthesiology

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CLIA Record

Field Name Field Value
CLIA Number 10D2074917
LAB Type Physician Office
Facility Name COASTAL ANESTHESIA PA PAIN MGMT CLINIC
Street 1001 W COLLEGE BLVD STE H BLDG 2
City NICEVILLE
State FL
ZIP 32578
Phone 850 279-4417
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/18/2024
Certificate Expiration Date 3/17/2026
Facility Type Physician Office
Lab Director MICHAEL P. EDERER

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