17D2257171 CLIA NUMBER - ADVANCED AMBULATORY SURGERY CENTER, LLC

Laboratory Demographics

  • CLIA Code: 17D2257171
  • Facility Name: ADVANCED AMBULATORY SURGERY CENTER, LLC
  • Facility Address: 4695 E 37TH ST N
    WICHITA, KS
    ZIP 67220
  • Facility Phone: 316 440-1276
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: JON C. PARKS
  • NPI Number: 1083982037
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 17D2257171
LAB Type Ambulatory Surgery Center
Facility Name ADVANCED AMBULATORY SURGERY CENTER, LLC
Street 4695 E 37TH ST N
City WICHITA
State KS
ZIP 67220
Phone 316 440-1276
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/31/2024
Certificate Expiration Date 3/30/2026
Facility Type Ambulatory Surgery Center
Lab Director JON C. PARKS

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