10D2153558 CLIA NUMBER - INTRACOASTAL SURGERY CENTER, LLC

Laboratory Demographics

  • CLIA Code: 10D2153558
  • Facility Name: INTRACOASTAL SURGERY CENTER, LLC
  • Facility Address: 2200 W EAU GALLIE BLVD STE 100
    MELBOURNE, FL
    ZIP 32935
  • Facility Phone: 321 795-6095
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: KYLE MOYLES
  • NPI Number: 1326527680
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D2153558
LAB Type Ambulatory Surgery Center
Facility Name INTRACOASTAL SURGERY CENTER, LLC
Street 2200 W EAU GALLIE BLVD STE 100
City MELBOURNE
State FL
ZIP 32935
Phone 321 795-6095
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/28/2024
Certificate Expiration Date 8/27/2026
Facility Type Ambulatory Surgery Center
Lab Director KYLE MOYLES

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