10D2229362 CLIA NUMBER - RIVERSIDE KINGSLEY ENDOSCOPY SURGICENTER LLC DBA KINGSLEY ENDOSCOPY CENTER

Laboratory Demographics

  • CLIA Code: 10D2229362
  • Facility Name: RIVERSIDE KINGSLEY ENDOSCOPY SURGICENTER LLC DBA KINGSLEY ENDOSCOPY CENTER
  • Facility Address: 870 KINGSLEY AVENUE
    ORANGE PARK, FL
    ZIP 32073
  • Facility Phone: 904 388-8686
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: SAMIR HABASHI
  • NPI Number: 1831700855
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2229362
LAB Type Ambulatory Surgery Center
Facility Name RIVERSIDE KINGSLEY ENDOSCOPY SURGICENTER LLC DBA KINGSLEY ENDOSCOPY CENTER
Street 870 KINGSLEY AVENUE
City ORANGE PARK
State FL
ZIP 32073
Phone 904 388-8686
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/12/2025
Certificate Expiration Date 7/11/2027
Facility Type Ambulatory Surgery Center
Lab Director SAMIR HABASHI

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