18D1033740 CLIA NUMBER - LOURDES AMBULATORY SURGERY CENTER, LLC

Laboratory Demographics

CLIA Number: 18D1033740

Facility Name: LOURDES AMBULATORY SURGERY CENTER, LLC

Facility Address:
225 MEDICAL CENTER DRIVE, SUITE 105
PADUCAH, KY
ZIP 42003
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Facility Phone Number: 270 441-4500

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1326048091

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	18D1033740
LAB Type	Ambulatory Surgery Center
Facility Name	LOURDES AMBULATORY SURGERY CENTER, LLC
Street	225 MEDICAL CENTER DRIVE, SUITE 105
City	PADUCAH
State	KY
ZIP	42003
Phone	270 441-4500
CertificateType	4
CertificateEffectiveDate	11/16/2022
CertificateExpirationDate	11/15/2024
FacilityType	Waiver

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