10D1087284 CLIA NUMBER - RIVERWALK AMBULATORY SURGERY CENTER LLC

Laboratory Demographics

CLIA Number: 10D1087284

Facility Name: RIVERWALK AMBULATORY SURGERY CENTER LLC

Facility Address:
200 3RD AVENUE WEST SUITE 170
BRADENTON, FL
ZIP 34205
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Facility Phone Number: 941 782-5439

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1588839609

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D1087284
LAB Type	Ambulatory Surgery Center
Facility Name	RIVERWALK AMBULATORY SURGERY CENTER LLC
Street	200 3RD AVENUE WEST SUITE 170
City	BRADENTON
State	FL
ZIP	34205
Phone	941 782-5439
CertificateType	4
CertificateEffectiveDate	7/31/2022
CertificateExpirationDate	7/30/2024
FacilityType	Waiver

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