03D2184401 CLIA NUMBER - REGENCY AMBULATORY SURGERY CENTER ONE LLC

Laboratory Demographics

  • CLIA Code: 03D2184401
  • Facility Name: REGENCY AMBULATORY SURGERY CENTER ONE LLC
  • Facility Address: 14725 W MOUNTAIN VIEW BLVD SUITE 125
    SURPRISE, AZ
    ZIP 85374
  • Facility Phone: 623 251-6431
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: JASON L. MUSSMAN
  • NPI Number: 1073155834
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 03D2184401
LAB Type Ambulatory Surgery Center
Facility Name REGENCY AMBULATORY SURGERY CENTER ONE LLC
Street 14725 W MOUNTAIN VIEW BLVD SUITE 125
City SURPRISE
State AZ
ZIP 85374
Phone 623 251-6431
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/19/2024
Certificate Expiration Date 5/18/2026
Facility Type Ambulatory Surgery Center
Lab Director JASON L. MUSSMAN

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