10D2096332 CLIA NUMBER - PHYSICIANS GROUP SERVICES DBA COASTAL SPINE AND PAIN CENTER

Laboratory Demographics

  • CLIA Code: 10D2096332
  • Facility Name: PHYSICIANS GROUP SERVICES DBA COASTAL SPINE AND PAIN CENTER
  • Facility Address: 1564 KINGSLEY AVE
    ORANGE PARK, FL
    ZIP 32073
  • Facility Phone: 904 282-6331
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KENNETH POWELL
  • NPI Number: 1649584079
  • Taxonomy: 208VP0000X - Pain Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D2096332
LAB Type Physician Office
Facility Name PHYSICIANS GROUP SERVICES DBA COASTAL SPINE AND PAIN CENTER
Street 1564 KINGSLEY AVE
City ORANGE PARK
State FL
ZIP 32073
Phone 904 282-6331
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/20/2025
Certificate Expiration Date 5/19/2027
Facility Type Physician Office
Lab Director KENNETH POWELL

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