10D0721298 CLIA NUMBER - COUNTRYSIDE SURGERY CENTER

Laboratory Demographics

CLIA Number: 10D0721298

Facility Name: COUNTRYSIDE SURGERY CENTER

Facility Address:
3291 N MCMULLEN BOOTH RD
CLEARWATER, FL
ZIP 33755
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Facility Phone Number: 727 725-5800

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1518920040

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D0721298
LAB Type	Ambulatory Surgery Center
Facility Name	COUNTRYSIDE SURGERY CENTER
Street	3291 N MCMULLEN BOOTH RD
City	CLEARWATER
State	FL
ZIP	33755
Phone	727 725-5800
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