10D2103376 CLIA NUMBER - PORT ORANGE ENDOSCOPY & SURGERY CENTER, LLC DBA ADVENTHEALTH SURGERY CENTER PORT ORANGE

Laboratory Demographics

  • CLIA Code: 10D2103376
  • Facility Name: PORT ORANGE ENDOSCOPY & SURGERY CENTER, LLC DBA ADVENTHEALTH SURGERY CENTER PORT ORANGE
  • Facility Address: 1185 DUNLAWTON AVE STE 100
    PORT ORANGE, FL
    ZIP 32127
  • Facility Phone: 386 672-0017
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: TIMOTHY J. TOLLAND
  • NPI Number: 1619979580
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D2103376
LAB Type Ambulatory Surgery Center
Facility Name PORT ORANGE ENDOSCOPY & SURGERY CENTER, LLC DBA ADVENTHEALTH SURGERY CENTER PORT ORANGE
Street 1185 DUNLAWTON AVE STE 100
City PORT ORANGE
State FL
ZIP 32127
Phone 386 672-0017
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/12/2025
Certificate Expiration Date 10/11/2027
Facility Type Ambulatory Surgery Center
Lab Director TIMOTHY J. TOLLAND

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