10D2266542 CLIA NUMBER - ORANGE AVENUE SURGERY CENTER, LLC

Laboratory Demographics

CLIA Number: 10D2266542

Facility Name: ORANGE AVENUE SURGERY CENTER, LLC

Facility Address:
1405 SOUTH ORANGE AVENUE, SUITE 120
ORLANDO, FL
ZIP 32806
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Facility Phone Number: 321 228-6700

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1790442895

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2266542
LAB Type	Ambulatory Surgery Center
Facility Name	ORANGE AVENUE SURGERY CENTER, LLC
Street	1405 SOUTH ORANGE AVENUE, SUITE 120
City	ORLANDO
State	FL
ZIP	32806
Phone	321 228-6700
CertificateType	4
CertificateEffectiveDate	8/11/2022
CertificateExpirationDate	8/10/2024
FacilityType	Waiver

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