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03D1103484 CLIA NUMBER - FLAGSTAFF SURGICAL ASSOCIATES

Laboratory Demographics

CLIA Number: 03D1103484

Facility Name: FLAGSTAFF SURGICAL ASSOCIATES

Facility Address:
77 W FOREST AVE SUITE 201
FLAGSTAFF, AZ
ZIP 86001
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Facility Phone Number: 928 773-2222

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1114995271

Taxonomy: 2086S0102X - Surgery
A surgeon with expertise in the management of the critically ill and postoperative patient, particularly the trauma victim, who specializes in critical care medicine diagnoses, treats and supports patients with multiple organ dysfunction. This specialist may have administrative responsibilities for intensive care units and may also facilitate and coordinate patient care among the primary physician, the critical care staff and other specialists.

CLIA Record

Field Name Field Value
CLIA Number 03D1103484
LAB Type Physician Office
Facility Name FLAGSTAFF SURGICAL ASSOCIATES
Street 77 W FOREST AVE SUITE 201
City FLAGSTAFF
State AZ
ZIP 86001
Phone 928 773-2222
CertificateType 4
CertificateEffectiveDate 12/1/2022
CertificateExpirationDate 11/30/2024
FacilityType Waiver

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