10D1074553 CLIA NUMBER - LAKE ENDOSCOPY CENTER LLC

Laboratory Demographics

  • CLIA Code: 10D1074553
  • Facility Name: LAKE ENDOSCOPY CENTER LLC
  • Facility Address: 17355 SE 109TH TERRACE ROAD
    SUMMERFIELD, FL
    ZIP 34491
  • Facility Phone: 352 245-0846
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: ASHWIN RUMALLA
  • NPI Number: 1750823886
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D1074553
LAB Type Ambulatory Surgery Center
Facility Name LAKE ENDOSCOPY CENTER LLC
Street 17355 SE 109TH TERRACE ROAD
City SUMMERFIELD
State FL
ZIP 34491
Phone 352 245-0846
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/1/2025
Certificate Expiration Date 9/30/2027
Facility Type Ambulatory Surgery Center
Lab Director ASHWIN RUMALLA

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