10D0934525 CLIA NUMBER - HERNANDO ENDOSCOPY & SURGERY CENTER

Laboratory Demographics

CLIA Number: 10D0934525

Facility Name: HERNANDO ENDOSCOPY & SURGERY CENTER

Facility Address:
12180 CORTEZ BLVD
BROOKSVILLE, FL
ZIP 34613
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Facility Phone Number: 352 596-4999

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1609969302

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D0934525
LAB Type	Ambulatory Surgery Center
Facility Name	HERNANDO ENDOSCOPY & SURGERY CENTER
Street	12180 CORTEZ BLVD
City	BROOKSVILLE
State	FL
ZIP	34613
Phone	352 596-4999
CertificateType	4
CertificateEffectiveDate	10/7/2023
CertificateExpirationDate	10/6/2025
FacilityType	Waiver

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