03D2264630 CLIA NUMBER - BSC 2 LLC DBA BANNER SURGERY CENTER SPORTS MEDICINE

Laboratory Demographics

CLIA Number: 03D2264630

Facility Name: BSC 2 LLC DBA BANNER SURGERY CENTER SPORTS MEDICINE

Facility Address:
9439 E IRONWOOD SQUARE DR STE 100
SCOTTSDALE, AZ
ZIP 85258
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Facility Phone Number: 480 355-3750

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1003556812

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	03D2264630
LAB Type	Ambulatory Surgery Center
Facility Name	BSC 2 LLC DBA BANNER SURGERY CENTER SPORTS MEDICINE
Street	9439 E IRONWOOD SQUARE DR STE 100
City	SCOTTSDALE
State	AZ
ZIP	85258
Phone	480 355-3750
CertificateType	4
CertificateEffectiveDate	7/18/2022
CertificateExpirationDate	7/17/2024
FacilityType	Waiver

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