03D2130966 CLIA NUMBER - Ideal Surgical Center

Laboratory Demographics

CLIA Number: 03D2130966

Facility Name: Ideal Surgical Center

Facility Address:
6424 E Broadway Rd, Ste 102
Mesa, AZ
ZIP 85206
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Facility Phone Number: (480) 634-4606

Facility Type: AMBULATORY SURGERY CENTER

Certificate Type: Waiver

NPI Number: 1568008167

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name Field Value
CLIA Number 03D2130966
LAB Type AMBULATORY SURGERY CENTER
Facility Name Ideal Surgical Center
Street 6424 E Broadway Rd, Ste 102
City Mesa
State AZ
ZIP 85206
Phone (480) 634-4606

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This page was last updated on: 4/7/2021