05D0986727 CLIA NUMBER - PREMIER OUTPATIENT SURGERY CENTER

Laboratory Demographics

CLIA Number: 05D0986727

Facility Name: PREMIER OUTPATIENT SURGERY CENTER

Facility Address:
1003 E BRIER DR, STE 170
SAN BERNARDINO, CA
ZIP 92408
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Facility Phone Number: 909 370-2190

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1629313739

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0986727
LAB Type	Ambulatory Surgery Center
Facility Name	PREMIER OUTPATIENT SURGERY CENTER
Street	1003 E BRIER DR, STE 170
City	SAN BERNARDINO
State	CA
ZIP	92408
Phone	909 370-2190
CertificateType	4
CertificateEffectiveDate	5/22/2023
CertificateExpirationDate	5/21/2025
FacilityType	Waiver

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