13D2017234 CLIA NUMBER - MEADOW LAKE SURGERY CENTER

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Laboratory Demographics

CLIA Number: 13D2017234

Facility Name: MEADOW LAKE SURGERY CENTER

Facility Address:
3630 E LOUISE DR
MERIDIAN, ID
ZIP 83642
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Facility Phone Number: 208 377-9515

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1740479476

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	13D2017234
LAB Type	Ambulatory Surgery Center
Facility Name	MEADOW LAKE SURGERY CENTER
Street	3630 E LOUISE DR
City	MERIDIAN
State	ID
ZIP	83642
Phone	208 377-9515
CertificateType	4
CertificateEffectiveDate	12/7/2022
CertificateExpirationDate	12/6/2024
FacilityType	Waiver

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