10D2174506 CLIA NUMBER - PHYSICIANS GROUP SERVICES DBA COASTAL SPINE AND PAIN CENTER

Laboratory Demographics

  • CLIA Code: 10D2174506
  • Facility Name: PHYSICIANS GROUP SERVICES DBA COASTAL SPINE AND PAIN CENTER
  • Facility Address: 463386 SR 200 UNIT A
    YULEE, FL
    ZIP 32097
  • Facility Phone: 904 282-6331
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ALAN MILLER
  • NPI Number: 1164801767
  • Taxonomy: 208100000X - Physical Medicine & Rehabilitation

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CLIA Record

Field Name Field Value
CLIA Number 10D2174506
LAB Type Physician Office
Facility Name PHYSICIANS GROUP SERVICES DBA COASTAL SPINE AND PAIN CENTER
Street 463386 SR 200 UNIT A
City YULEE
State FL
ZIP 32097
Phone 904 282-6331
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/4/2023
Certificate Expiration Date 11/3/2025
Facility Type Physician Office
Lab Director ALAN MILLER

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