03D2187392 CLIA NUMBER - DEER VALLEY SURGICAL AND ENDOSCOPY CENTER

Laboratory Demographics

CLIA Number: 03D2187392

Facility Name: DEER VALLEY SURGICAL AND ENDOSCOPY CENTER

Facility Address:
19646 N 27TH AVE, SUITE 204
PHOENIX, AZ
ZIP 85027
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Facility Phone Number: 602 633-3097

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1811940554

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	03D2187392
LAB Type	Ambulatory Surgery Center
Facility Name	DEER VALLEY SURGICAL AND ENDOSCOPY CENTER
Street	19646 N 27TH AVE, SUITE 204
City	PHOENIX
State	AZ
ZIP	85027
Phone	602 633-3097
CertificateType	4
CertificateEffectiveDate	7/1/2022
CertificateExpirationDate	6/30/2024
FacilityType	Waiver

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