10D0997759 CLIA NUMBER - PROMENADES SURGERY CENTER LLC

Laboratory Demographics

  • CLIA Code: 10D0997759
  • Facility Name: PROMENADES SURGERY CENTER LLC
  • Facility Address: 3222 TAMIAMI TRAIL
    PORT CHARLOTTE, FL
    ZIP 33952
  • Facility Phone: 941 627-5155
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: ISSA F. BAROUDI
  • NPI Number: 1336181742
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D0997759
LAB Type Ambulatory Surgery Center
Facility Name PROMENADES SURGERY CENTER LLC
Street 3222 TAMIAMI TRAIL
City PORT CHARLOTTE
State FL
ZIP 33952
Phone 941 627-5155
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/27/2024
Certificate Expiration Date 3/26/2026
Facility Type Ambulatory Surgery Center
Lab Director ISSA F. BAROUDI

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