10D2071596 CLIA NUMBER - LEGACY SURGERY CENTER LLC

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Laboratory Demographics

CLIA Number: 10D2071596

Facility Name: LEGACY SURGERY CENTER LLC

Facility Address:
6918 GUNN HWY
TAMPA, FL
ZIP 33625
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Facility Phone Number: 813 852-2500

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1699256404

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2071596
LAB Type	Ambulatory Surgery Center
Facility Name	LEGACY SURGERY CENTER LLC
Street	6918 GUNN HWY
City	TAMPA
State	FL
ZIP	33625
Phone	813 852-2500
CertificateType	4
CertificateEffectiveDate	1/15/2024
CertificateExpirationDate	1/14/2026
FacilityType	Waiver

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