14D2047582 CLIA NUMBER - PHYSICIANS SURGERY CENTER AT GOOD SAMARITAN L L C

Home > CLIA Lookup > 14D2047582

Laboratory Demographics

CLIA Number: 14D2047582

Facility Name: PHYSICIANS SURGERY CENTER AT GOOD SAMARITAN L L C

Facility Address:
2 GOOD SAMARITAN WAY, STE 200
MOUNT VERNON, IL
ZIP 62864
Get Directions

Facility Phone Number: 618 899-5703

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1285980151

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2047582
LAB Type	Ambulatory Surgery Center
Facility Name	PHYSICIANS SURGERY CENTER AT GOOD SAMARITAN L L C
Street	2 GOOD SAMARITAN WAY, STE 200
City	MOUNT VERNON
State	IL
ZIP	62864
Phone	618 899-5703
CertificateType	4
CertificateEffectiveDate	9/26/2022
CertificateExpirationDate	9/25/2024
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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