10D2149195 CLIA NUMBER - AMELIA ISLAND SURGERY CENTER, LLC

Laboratory Demographics

  • CLIA Code: 10D2149195
  • Facility Name: AMELIA ISLAND SURGERY CENTER, LLC
  • Facility Address: 2416 LYNNDALE ROAD
    FERNANDINA BEACH, FL
    ZIP 32034
  • Facility Phone: 904 775-5280
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: JAMES R. STACKHOUSE
  • NPI Number: 1265473698
  • Taxonomy: 208200000X - Plastic Surgery

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CLIA Record

Field Name Field Value
CLIA Number 10D2149195
LAB Type Ambulatory Surgery Center
Facility Name AMELIA ISLAND SURGERY CENTER, LLC
Street 2416 LYNNDALE ROAD
City FERNANDINA BEACH
State FL
ZIP 32034
Phone 904 775-5280
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/29/2024
Certificate Expiration Date 5/28/2026
Facility Type Ambulatory Surgery Center
Lab Director JAMES R. STACKHOUSE

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