05D2157596 CLIA NUMBER - CENTRAL CALIFORNIA SURGERY CENTER

Laboratory Demographics

CLIA Number: 05D2157596

Facility Name: CENTRAL CALIFORNIA SURGERY CENTER

Facility Address:
3605 HOSPITAL ROAD SUITE H
ATWATER, CA
ZIP 95301
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Facility Phone Number: 209 381-2047

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1528154986

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2157596
LAB Type	Ambulatory Surgery Center
Facility Name	CENTRAL CALIFORNIA SURGERY CENTER
Street	3605 HOSPITAL ROAD SUITE H
City	ATWATER
State	CA
ZIP	95301
Phone	209 381-2047
CertificateType	4
CertificateEffectiveDate	11/8/2022
CertificateExpirationDate	11/7/2024
FacilityType	Waiver

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