14D1077131 CLIA NUMBER - PHYSICIANS SURGERY CENTER L L C

Laboratory Demographics

  • CLIA Code: 14D1077131
  • Facility Name: PHYSICIANS SURGERY CENTER L L C
  • Facility Address: 2601 W MAIN
    CARBONDALE, IL
    ZIP 62901
  • Facility Phone: 618 351-7300
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: MARK J. GARWIN
  • NPI Number: 1023297553
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D1077131
LAB Type Ambulatory Surgery Center
Facility Name PHYSICIANS SURGERY CENTER L L C
Street 2601 W MAIN
City CARBONDALE
State IL
ZIP 62901
Phone 618 351-7300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/3/2023
Certificate Expiration Date 12/2/2025
Facility Type Ambulatory Surgery Center
Lab Director MARK J. GARWIN

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This page was last updated on: 9/29/2025