14D2163529 CLIA NUMBER - PHYSICIANS' SURGICAL CENTRE

Laboratory Demographics

CLIA Number: 14D2163529

Facility Name: PHYSICIANS' SURGICAL CENTRE

Facility Address:
741 INSIGHT AVE
O FALLON, IL
ZIP 62269
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Facility Phone Number: 618 239-0678

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1770042111

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2163529
LAB Type	Ambulatory Surgery Center
Facility Name	PHYSICIANS' SURGICAL CENTRE
Street	741 INSIGHT AVE
City	O FALLON
State	IL
ZIP	62269
Phone	618 239-0678
CertificateType	4
CertificateEffectiveDate	3/15/2023
CertificateExpirationDate	3/14/2025
FacilityType	Waiver

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