03D2163922 CLIA NUMBER - FORTITUDE SURGERY CENTER LLC

Laboratory Demographics

  • CLIA Code: 03D2163922
  • Facility Name: FORTITUDE SURGERY CENTER LLC
  • Facility Address: 5133 N CENTRAL AVE SUITE 200
    PHOENIX, AZ
    ZIP 85012
  • Facility Phone: 480 241-0026
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: NICHOLE E. VAUGHAN
  • NPI Number: 1043789118
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 03D2163922
LAB Type Ambulatory Surgery Center
Facility Name FORTITUDE SURGERY CENTER LLC
Street 5133 N CENTRAL AVE SUITE 200
City PHOENIX
State AZ
ZIP 85012
Phone 480 241-0026
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/22/2025
Certificate Expiration Date 3/21/2027
Facility Type Ambulatory Surgery Center
Lab Director NICHOLE E. VAUGHAN

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