03D2053506 CLIA NUMBER - MODERN AMBULATORY SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 03D2053506
  • Facility Name: MODERN AMBULATORY SURGERY CENTER
  • Facility Address: 4860 E BASELINE RD STE 101
    MESA, AZ
    ZIP 85206
  • Facility Phone: 602 265-8800
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: AZMI N. NASSER
  • NPI Number: 1982031936
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 03D2053506
LAB Type Ambulatory Surgery Center
Facility Name MODERN AMBULATORY SURGERY CENTER
Street 4860 E BASELINE RD STE 101
City MESA
State AZ
ZIP 85206
Phone 602 265-8800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/1/2025
Certificate Expiration Date 1/31/2027
Facility Type Ambulatory Surgery Center
Lab Director AZMI N. NASSER

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