10D2269580 CLIA NUMBER - BEACHSIDE PRIMARY CARE LLC

Laboratory Demographics

  • CLIA Code: 10D2269580
  • Facility Name: BEACHSIDE PRIMARY CARE LLC
  • Facility Address: 1825B 3RD ST N
    JACKSONVILLE BEACH, FL
    ZIP 32250
  • Facility Phone: 904 595-5826
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DEBORAH L. GHANDOUR
  • NPI Number: 1386364032
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D2269580
LAB Type Physician Office
Facility Name BEACHSIDE PRIMARY CARE LLC
Street 1825B 3RD ST N
City JACKSONVILLE BEACH
State FL
ZIP 32250
Phone 904 595-5826
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/29/2024
Certificate Expiration Date 9/28/2026
Facility Type Physician Office
Lab Director DEBORAH L. GHANDOUR

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