01D1083067 CLIA NUMBER - ROUSSO FACIAL PLASTIC SURGERY PC

Laboratory Demographics

CLIA Number: 01D1083067

Facility Name: ROUSSO FACIAL PLASTIC SURGERY PC

Facility Address:
2700 HIGHWAY 280 SUITE 300 WEST
BIRMINGHAM, AL
ZIP 35223
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Facility Phone Number: 205 930-9595

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1225140627

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	01D1083067
LAB Type	Ambulatory Surgery Center
Facility Name	ROUSSO FACIAL PLASTIC SURGERY PC
Street	2700 HIGHWAY 280 SUITE 300 WEST
City	BIRMINGHAM
State	AL
ZIP	35223
Phone	205 930-9595
CertificateType	4
CertificateEffectiveDate	4/24/2024
CertificateExpirationDate	4/23/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024