10D2242694 CLIA NUMBER - SURGCENTER OF RIVERVIEW LLC DBA WEST FLORIDA SURGICAL SUITES

Laboratory Demographics

CLIA Number: 10D2242694

Facility Name: SURGCENTER OF RIVERVIEW LLC DBA WEST FLORIDA SURGICAL SUITES

Facility Address:
1715 N WEST SHORE BLVD STE 190
TAMPA, FL
ZIP 33607
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Facility Phone Number: 404 625-3208

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1023787488

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2242694
LAB Type	Ambulatory Surgery Center
Facility Name	SURGCENTER OF RIVERVIEW LLC DBA WEST FLORIDA SURGICAL SUITES
Street	1715 N WEST SHORE BLVD STE 190
City	TAMPA
State	FL
ZIP	33607
Phone	404 625-3208
CertificateType	4
CertificateEffectiveDate	11/10/2023
CertificateExpirationDate	11/9/2025
FacilityType	Waiver

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