06D1051802 CLIA NUMBER - ARKANSAS VALLEY SURGICAL CENTER

Laboratory Demographics

CLIA Number: 06D1051802

Facility Name: ARKANSAS VALLEY SURGICAL CENTER

Facility Address:
933 SELL AVE, STE B ATTN RAMONA MATHERNE
CANON CITY, CO
ZIP 81212
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Facility Phone Number: 719 275-6433

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1255495990

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	06D1051802
LAB Type	Ambulatory Surgery Center
Facility Name	ARKANSAS VALLEY SURGICAL CENTER
Street	933 SELL AVE, STE B ATTN RAMONA MATHERNE
City	CANON CITY
State	CO
ZIP	81212
Phone	719 275-6433
CertificateType	4
CertificateEffectiveDate	3/10/2024
CertificateExpirationDate	3/9/2026
FacilityType	Waiver

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