07D1093292 CLIA NUMBER - GLASTONBURY ENDOSCOPY CENTER LLC

Laboratory Demographics

CLIA Number: 07D1093292

Facility Name: GLASTONBURY ENDOSCOPY CENTER LLC

Facility Address:
300 WESTERN BLVD, SUITE # B
GLASTONBURY, CT
ZIP 06033
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Facility Phone Number: 714 843-5997

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1659525020

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	07D1093292
LAB Type	Ambulatory Surgery Center
Facility Name	GLASTONBURY ENDOSCOPY CENTER LLC
Street	300 WESTERN BLVD, SUITE # B
City	GLASTONBURY
State	CT
ZIP	06033
Phone	714 843-5997
CertificateType	4
CertificateEffectiveDate	12/16/2022
CertificateExpirationDate	12/15/2024
FacilityType	Waiver

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