10D1098690 CLIA NUMBER - PACAYA BAY SURGERY CENTER LLC

Laboratory Demographics

CLIA Number: 10D1098690

Facility Name: PACAYA BAY SURGERY CENTER LLC

Facility Address:
13981 MCGREGOR BLVD STE 102
FORT MYERS, FL
ZIP 33919
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Facility Phone Number: 239 275-4505

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1942454095

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D1098690
LAB Type	Ambulatory Surgery Center
Facility Name	PACAYA BAY SURGERY CENTER LLC
Street	13981 MCGREGOR BLVD STE 102
City	FORT MYERS
State	FL
ZIP	33919
Phone	239 275-4505
CertificateType	4
CertificateEffectiveDate	4/24/2023
CertificateExpirationDate	4/23/2025
FacilityType	Waiver

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