13D1017625 CLIA NUMBER - MILLENNIUM SURGERY CENTER

Laboratory Demographics

CLIA Number: 13D1017625

Facility Name: MILLENNIUM SURGERY CENTER

Facility Address:
1828 S MILLENNIUM WAY #100
MERIDIAN, ID
ZIP 83642
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Facility Phone Number: 208 381-0262

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1770598591

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	13D1017625
LAB Type	Ambulatory Surgery Center
Facility Name	MILLENNIUM SURGERY CENTER
Street	1828 S MILLENNIUM WAY #100
City	MERIDIAN
State	ID
ZIP	83642
Phone	208 381-0262
CertificateType	4
CertificateEffectiveDate	9/30/2023
CertificateExpirationDate	9/29/2025
FacilityType	Waiver

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