10D2168551 CLIA NUMBER - PERFORMANCE HEALTH SURGERY CENTER

Laboratory Demographics

CLIA Number: 10D2168551

Facility Name: PERFORMANCE HEALTH SURGERY CENTER

Facility Address:
9500 GULF RESEARCH LANE
FORT MYERS, FL
ZIP 33912
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Facility Phone Number: 239 314-0660

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1134684814

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2168551
LAB Type	Ambulatory Surgery Center
Facility Name	PERFORMANCE HEALTH SURGERY CENTER
Street	9500 GULF RESEARCH LANE
City	FORT MYERS
State	FL
ZIP	33912
Phone	239 314-0660
CertificateType	4
CertificateEffectiveDate	7/2/2023
CertificateExpirationDate	7/1/2025
FacilityType	Waiver

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