03D2024196 CLIA NUMBER - SAN TAN SURGERY CENTER

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Laboratory Demographics

CLIA Number: 03D2024196

Facility Name: SAN TAN SURGERY CENTER

Facility Address:
1704 EAST BOSTON STREET
GILBERT, AZ
ZIP 85295
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Facility Phone Number: 480 656-8600

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1033400619

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	03D2024196
LAB Type	Ambulatory Surgery Center
Facility Name	SAN TAN SURGERY CENTER
Street	1704 EAST BOSTON STREET
City	GILBERT
State	AZ
ZIP	85295
Phone	480 656-8600
CertificateType	4
CertificateEffectiveDate	5/11/2023
CertificateExpirationDate	5/10/2025
FacilityType	Waiver

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