34D1012190 CLIA NUMBER - JACKSONVILLE DIAGNOTIC IMAGING LLC DB COASTAL DIAGNOSTIC IMAGING

Laboratory Demographics

  • CLIA Code: 34D1012190
  • Facility Name: JACKSONVILLE DIAGNOTIC IMAGING LLC DB COASTAL DIAGNOSTIC IMAGING
  • Facility Address: 3606 HENDERSON DRIVE
    JACKSONVILLE, NC
    ZIP 28546
  • Facility Phone: 910 937-7226
  • Facility Type: Other - INDEPENDENT DIAGNOSTIC IM
  • Facility Type: Waiver
  • Lab Director: ELENA SANDERS
  • NPI Number: 1104874387
  • Taxonomy: 2085R0202X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 34D1012190
LAB Type Other - INDEPENDENT DIAGNOSTIC IM
Facility Name JACKSONVILLE DIAGNOTIC IMAGING LLC DB COASTAL DIAGNOSTIC IMAGING
Street 3606 HENDERSON DRIVE
City JACKSONVILLE
State NC
ZIP 28546
Phone 910 937-7226
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/4/2024
Certificate Expiration Date 11/3/2026
Facility Type Other - INDEPENDENT DIAGNOSTIC IM
Lab Director ELENA SANDERS

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