03D0902788 CLIA NUMBER - BANNER MESA SURGERY CENTER LLC

Laboratory Demographics

  • CLIA Code: 03D0902788
  • Facility Name: BANNER MESA SURGERY CENTER LLC
  • Facility Address: 1500 S DOBSON RD STE 101
    MESA, AZ
    ZIP 85202
  • Facility Phone: 480 412-3590
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: TAREK YOUSEFF
  • NPI Number: 1780109934
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 03D0902788
LAB Type Ambulatory Surgery Center
Facility Name BANNER MESA SURGERY CENTER LLC
Street 1500 S DOBSON RD STE 101
City MESA
State AZ
ZIP 85202
Phone 480 412-3590
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/29/2025
Certificate Expiration Date 6/28/2027
Facility Type Ambulatory Surgery Center
Lab Director TAREK YOUSEFF

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