10D2228152 CLIA NUMBER - SURGCENTER OF PINE RIDGE LLC

Laboratory Demographics

CLIA Number: 10D2228152

Facility Name: SURGCENTER OF PINE RIDGE LLC

Facility Address:
12871 TRADE WAY DR - STE 12
BONITA SPRINGS, FL
ZIP 34135
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Facility Phone Number: 239 478-0051

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1285202077

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2228152
LAB Type	Ambulatory Surgery Center
Facility Name	SURGCENTER OF PINE RIDGE LLC
Street	12871 TRADE WAY DR - STE 12
City	BONITA SPRINGS
State	FL
ZIP	34135
Phone	239 478-0051
CertificateType	4
CertificateEffectiveDate	6/23/2023
CertificateExpirationDate	6/22/2025
FacilityType	Waiver

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