10D2315511 CLIA NUMBER - MEDSTAR CLINIC LLC

Laboratory Demographics

  • CLIA Code: 10D2315511
  • Facility Name: MEDSTAR CLINIC LLC
  • Facility Address: 6817 SOUTHPOINT PARKWAY SUITE 1302
    JACKSONVILLE, FL
    ZIP 32216
  • Facility Phone: 904 902-0091
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MOHAMED E. SHAALAN
  • NPI Number: 1528809373
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D2315511
LAB Type Physician Office
Facility Name MEDSTAR CLINIC LLC
Street 6817 SOUTHPOINT PARKWAY SUITE 1302
City JACKSONVILLE
State FL
ZIP 32216
Phone 904 902-0091
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/13/2024
Certificate Expiration Date 12/12/2026
Facility Type Physician Office
Lab Director MOHAMED E. SHAALAN

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