10D0711943 CLIA NUMBER - FORT MYERS CHILDREN'S SURGERY CENTER, LLC

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Laboratory Demographics

CLIA Number: 10D0711943

Facility Name: FORT MYERS CHILDREN'S SURGERY CENTER, LLC

Facility Address:
3700 CENTRAL AVENUE SUITE 2
FORT MYERS, FL
ZIP 33901
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Facility Phone Number: 717 759-4375

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1669997961

Taxonomy: 2085R0202X - Radiology
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

CLIA Record

Field Name	Field Value
CLIA Number	10D0711943
LAB Type	Ambulatory Surgery Center
Facility Name	FORT MYERS CHILDREN'S SURGERY CENTER, LLC
Street	3700 CENTRAL AVENUE SUITE 2
City	FORT MYERS
State	FL
ZIP	33901
Phone	717 759-4375
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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