10D0963118 CLIA NUMBER - LAKESIDE SURGERY CENTER

Laboratory Demographics

CLIA Number: 10D0963118

Facility Name: LAKESIDE SURGERY CENTER

Facility Address:
1825 NORTH MILLS AVE
ORLANDO, FL
ZIP 32803
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Facility Phone Number: 407 206-2375

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1477507168

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D0963118
LAB Type	Ambulatory Surgery Center
Facility Name	LAKESIDE SURGERY CENTER
Street	1825 NORTH MILLS AVE
City	ORLANDO
State	FL
ZIP	32803
Phone	407 206-2375
CertificateType	4
CertificateEffectiveDate	7/23/2023
CertificateExpirationDate	7/22/2025
FacilityType	Waiver

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