03D2240028 CLIA NUMBER - PRINCIPAL SURGICAL CENTER

Laboratory Demographics

  • CLIA Code: 03D2240028
  • Facility Name: PRINCIPAL SURGICAL CENTER
  • Facility Address: 6424 E BROADWAY RD STE 102
    MESA, AZ
    ZIP 85206
  • Facility Phone: 480 634-4605
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: TYLER CHURCH
  • NPI Number: 1528730751
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 03D2240028
LAB Type Ambulatory Surgery Center
Facility Name PRINCIPAL SURGICAL CENTER
Street 6424 E BROADWAY RD STE 102
City MESA
State AZ
ZIP 85206
Phone 480 634-4605
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/15/2023
Certificate Expiration Date 10/14/2025
Facility Type Ambulatory Surgery Center
Lab Director TYLER CHURCH

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