10D2084363 CLIA NUMBER - SIMONSEN & MADDERN PEDIATRIC ENT, PLLC

Laboratory Demographics

  • CLIA Code: 10D2084363
  • Facility Name: SIMONSEN & MADDERN PEDIATRIC ENT, PLLC
  • Facility Address: 10475 CENTURION PKWY N CENTER ONE OFFICE BUILDING - 3RD FL STE 302
    JACKSONVILLE, FL
    ZIP 32256
  • Facility Phone: 904 398-5437
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ANDREW R. SIMONSEN
  • NPI Number: 1528030418
  • Taxonomy: 207YP0228X - Otolaryngology

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CLIA Record

Field Name Field Value
CLIA Number 10D2084363
LAB Type Physician Office
Facility Name SIMONSEN & MADDERN PEDIATRIC ENT, PLLC
Street 10475 CENTURION PKWY N CENTER ONE OFFICE BUILDING - 3RD FL STE 302
City JACKSONVILLE
State FL
ZIP 32256
Phone 904 398-5437
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/23/2024
Certificate Expiration Date 9/22/2026
Facility Type Physician Office
Lab Director ANDREW R. SIMONSEN

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