10D2172384 CLIA NUMBER - SUMMERPORT SURGERY CENTER LLC

Laboratory Demographics

  • CLIA Code: 10D2172384
  • Facility Name: SUMMERPORT SURGERY CENTER LLC
  • Facility Address: 5151 WINTER GARDEN VINELAND ROAD, SUITE 108
    WINDERMERE, FL
    ZIP 34786
  • Facility Phone: 321 228-6700
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: JOSHUA GRIFFIN
  • NPI Number: 1942775762
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D2172384
LAB Type Ambulatory Surgery Center
Facility Name SUMMERPORT SURGERY CENTER LLC
Street 5151 WINTER GARDEN VINELAND ROAD, SUITE 108
City WINDERMERE
State FL
ZIP 34786
Phone 321 228-6700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/23/2025
Certificate Expiration Date 9/22/2027
Facility Type Ambulatory Surgery Center
Lab Director JOSHUA GRIFFIN

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