01D2109847 CLIA NUMBER - EASTERN SHORE COSMETIC SURGERY

Laboratory Demographics

CLIA Number: 01D2109847

Facility Name: EASTERN SHORE COSMETIC SURGERY

Facility Address:
7541 CIPRIANO COURT
FAIRHOPE, AL
ZIP 36532
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Facility Phone Number: 251 929-7850

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1699068783

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	01D2109847
LAB Type	Ambulatory Surgery Center
Facility Name	EASTERN SHORE COSMETIC SURGERY
Street	7541 CIPRIANO COURT
City	FAIRHOPE
State	AL
ZIP	36532
Phone	251 929-7850
CertificateType	4
CertificateEffectiveDate	3/3/2024
CertificateExpirationDate	3/2/2026
FacilityType	Waiver

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