10D2117203 CLIA NUMBER - SURGCENTER OF ST LUCIE LLC

Laboratory Demographics

CLIA Number: 10D2117203

Facility Name: SURGCENTER OF ST LUCIE LLC

Facility Address:
10521 SW VILLAGE CENTER DR STE 104
PORT SAINT LUCIE, FL
ZIP 34987
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Facility Phone Number: 919 812-7657

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1053764779

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2117203
LAB Type	Ambulatory Surgery Center
Facility Name	SURGCENTER OF ST LUCIE LLC
Street	10521 SW VILLAGE CENTER DR STE 104
City	PORT SAINT LUCIE
State	FL
ZIP	34987
Phone	919 812-7657
CertificateType	4
CertificateEffectiveDate	8/10/2022
CertificateExpirationDate	8/9/2024
FacilityType	Waiver

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