07D2108772 CLIA NUMBER - BLOOMFIELD AMBULATORY SURGEY CENTER, LLC

Laboratory Demographics

CLIA Number: 07D2108772

Facility Name: BLOOMFIELD AMBULATORY SURGEY CENTER, LLC

Facility Address:
580 COTTAGE GROVE RD, SUITE 211
BLOOMFIELD, CT
ZIP 06002
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Facility Phone Number: 860 242-2193

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1255797726

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	07D2108772
LAB Type	Ambulatory Surgery Center
Facility Name	BLOOMFIELD AMBULATORY SURGEY CENTER, LLC
Street	580 COTTAGE GROVE RD, SUITE 211
City	BLOOMFIELD
State	CT
ZIP	06002
Phone	860 242-2193
CertificateType	4
CertificateEffectiveDate	2/11/2024
CertificateExpirationDate	2/10/2026
FacilityType	Waiver

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