16D1058574 CLIA NUMBER - WEST LAKES SURGERY CENTER,LLC

Laboratory Demographics

  • CLIA Code: 16D1058574
  • Facility Name: WEST LAKES SURGERY CENTER,LLC
  • Facility Address: 12499 UNIVERSITY AVENUE, SUITE 100
    CLIVE, IA
    ZIP 50325
  • Facility Phone: 515 974-5050
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: TERI S. FORMANEK
  • NPI Number: 1104933696
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 16D1058574
LAB Type Ambulatory Surgery Center
Facility Name WEST LAKES SURGERY CENTER,LLC
Street 12499 UNIVERSITY AVENUE, SUITE 100
City CLIVE
State IA
ZIP 50325
Phone 515 974-5050
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/8/2024
Certificate Expiration Date 9/7/2026
Facility Type Ambulatory Surgery Center
Lab Director TERI S. FORMANEK

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