10D2095542 CLIA NUMBER - SELECT PHYSICIANS SURGERY CENTER

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Laboratory Demographics

CLIA Number: 10D2095542

Facility Name: SELECT PHYSICIANS SURGERY CENTER

Facility Address:
3440 W DR MARTIN LUTHER KING BLVD STE 103
TAMPA, FL
ZIP 33607
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Facility Phone Number: 813 321-1618

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1326435926

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2095542
LAB Type	Ambulatory Surgery Center
Facility Name	SELECT PHYSICIANS SURGERY CENTER
Street	3440 W DR MARTIN LUTHER KING BLVD STE 103
City	TAMPA
State	FL
ZIP	33607
Phone	813 321-1618
CertificateType	4
CertificateEffectiveDate	5/7/2023
CertificateExpirationDate	5/6/2025
FacilityType	Waiver

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