03D1055909 CLIA NUMBER - TRI-CITY SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 03D1055909
  • Facility Name: TRI-CITY SURGERY CENTER
  • Facility Address: 5430 DISTINCTION WAY
    PRESCOTT, AZ
    ZIP 86301
  • Facility Phone: 928 445-1919
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: RICHARD PLEVA
  • NPI Number: 1598229593
  • Taxonomy: 207RG0100X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 03D1055909
LAB Type Ambulatory Surgery Center
Facility Name TRI-CITY SURGERY CENTER
Street 5430 DISTINCTION WAY
City PRESCOTT
State AZ
ZIP 86301
Phone 928 445-1919
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/29/2024
Certificate Expiration Date 6/28/2026
Facility Type Ambulatory Surgery Center
Lab Director RICHARD PLEVA

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