13D2106536 CLIA NUMBER - SOUTHERN IDAHO SURGERY CENTER

Laboratory Demographics

CLIA Number: 13D2106536

Facility Name: SOUTHERN IDAHO SURGERY CENTER

Facility Address:
3235 N TOWERBRIDGE WAY #100
MERIDIAN, ID
ZIP 83646
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Facility Phone Number: 208 895-6611

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1396069902

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	13D2106536
LAB Type	Ambulatory Surgery Center
Facility Name	SOUTHERN IDAHO SURGERY CENTER
Street	3235 N TOWERBRIDGE WAY #100
City	MERIDIAN
State	ID
ZIP	83646
Phone	208 895-6611
CertificateType	4
CertificateEffectiveDate	12/21/2023
CertificateExpirationDate	12/20/2025
FacilityType	Waiver

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