02D2155324 CLIA NUMBER - SUSITNA SURGERY CENTER, LLC

Laboratory Demographics

CLIA Number: 02D2155324

Facility Name: SUSITNA SURGERY CENTER, LLC

Facility Address:
2490 S WOODWORTH LOOP, SUITE 100
PALMER, AK
ZIP 99645
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Facility Phone Number: 907 861-6540

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1073009304

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	02D2155324
LAB Type	Ambulatory Surgery Center
Facility Name	SUSITNA SURGERY CENTER, LLC
Street	2490 S WOODWORTH LOOP, SUITE 100
City	PALMER
State	AK
ZIP	99645
Phone	907 861-6540
CertificateType	4
CertificateEffectiveDate	9/27/2022
CertificateExpirationDate	9/26/2024
FacilityType	Waiver

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