10D1056544 CLIA NUMBER - TRAILS EDGE SURGERY CENTER LLC

Laboratory Demographics

CLIA Number: 10D1056544

Facility Name: TRAILS EDGE SURGERY CENTER LLC

Facility Address:
28930 TRAILS EDGE BLVD STE 100
BONITA SPRINGS, FL
ZIP 34134
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Facility Phone Number: 239 495-4300

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1639650161

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D1056544
LAB Type	Ambulatory Surgery Center
Facility Name	TRAILS EDGE SURGERY CENTER LLC
Street	28930 TRAILS EDGE BLVD STE 100
City	BONITA SPRINGS
State	FL
ZIP	34134
Phone	239 495-4300
CertificateType	4
CertificateEffectiveDate	7/19/2022
CertificateExpirationDate	7/18/2024
FacilityType	Waiver

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