10D2158330 CLIA NUMBER - ISLAND DIRECT PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 10D2158330
  • Facility Name: ISLAND DIRECT PRIMARY CARE
  • Facility Address: 390 NORTH COURTENAY PKWY
    MERRITT ISLAND, FL
    ZIP 32952
  • Facility Phone: 321 506-2540
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: JOHN W. ROTHWELL III
  • NPI Number: 1811463961
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D2158330
LAB Type Practitioner Other
Facility Name ISLAND DIRECT PRIMARY CARE
Street 390 NORTH COURTENAY PKWY
City MERRITT ISLAND
State FL
ZIP 32952
Phone 321 506-2540
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/27/2024
Certificate Expiration Date 11/26/2026
Facility Type Practitioner Other
Lab Director JOHN W. ROTHWELL III

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