17D2174487 CLIA NUMBER - ANDOVER AMBULATORY SURGERY CENTER, LLC

Laboratory Demographics

  • CLIA Code: 17D2174487
  • Facility Name: ANDOVER AMBULATORY SURGERY CENTER, LLC
  • Facility Address: 1124 W 21ST STREET, SUITE 100
    ANDOVER, KS
    ZIP 67002
  • Facility Phone: 316 300-4771
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: PATTI A. COLLINS
  • NPI Number: 1770147217
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 17D2174487
LAB Type Ambulatory Surgery Center
Facility Name ANDOVER AMBULATORY SURGERY CENTER, LLC
Street 1124 W 21ST STREET, SUITE 100
City ANDOVER
State KS
ZIP 67002
Phone 316 300-4771
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/1/2023
Certificate Expiration Date 10/31/2025
Facility Type Ambulatory Surgery Center
Lab Director PATTI A. COLLINS

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