02D2098119 CLIA NUMBER - WW ENTERPRISE LLC

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Laboratory Demographics

CLIA Number: 02D2098119

Facility Name: WW ENTERPRISE LLC

Facility Address:
2485 CHIEF WILLIAM DR SUITE 100
FAIRBANKS, AK
ZIP 99709
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Facility Phone Number: 907 457-5277

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1184016461

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	02D2098119
LAB Type	Ambulatory Surgery Center
Facility Name	WW ENTERPRISE LLC
Street	2485 CHIEF WILLIAM DR SUITE 100
City	FAIRBANKS
State	AK
ZIP	99709
Phone	907 457-5277
CertificateType	4
CertificateEffectiveDate	6/30/2023
CertificateExpirationDate	6/29/2025
FacilityType	Waiver

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