10D1034504 CLIA NUMBER - WEST PARK SURGERY CENTER

Laboratory Demographics

CLIA Number: 10D1034504

Facility Name: WEST PARK SURGERY CENTER

Facility Address:
6640 78TH AVE N STE B
PINELLAS PARK, FL
ZIP 33781
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Facility Phone Number: 727 549-0610

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1043272750

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D1034504
LAB Type	Ambulatory Surgery Center
Facility Name	WEST PARK SURGERY CENTER
Street	6640 78TH AVE N STE B
City	PINELLAS PARK
State	FL
ZIP	33781
Phone	727 549-0610
CertificateType	4
CertificateEffectiveDate	12/6/2022
CertificateExpirationDate	12/5/2024
FacilityType	Waiver

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