10D0925298 CLIA NUMBER - LAKE CITY SURGERY CENTER LLC

Laboratory Demographics

  • CLIA Code: 10D0925298
  • Facility Name: LAKE CITY SURGERY CENTER LLC
  • Facility Address: 208 SW PROSPERITY PLACE
    LAKE CITY, FL
    ZIP 32024
  • Facility Phone: 386 487-3930
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: RIZWANA S. THANALA
  • NPI Number: 1598965634
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D0925298
LAB Type Ambulatory Surgery Center
Facility Name LAKE CITY SURGERY CENTER LLC
Street 208 SW PROSPERITY PLACE
City LAKE CITY
State FL
ZIP 32024
Phone 386 487-3930
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/10/2024
Certificate Expiration Date 5/9/2026
Facility Type Ambulatory Surgery Center
Lab Director RIZWANA S. THANALA

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This page was last updated on: 9/29/2025