19D0723122 CLIA NUMBER - SHREVEPORT SURGERY CENTER

Laboratory Demographics

CLIA Number: 19D0723122

Facility Name: SHREVEPORT SURGERY CENTER

Facility Address:
745 OLIVE STREET SUITE 100
SHREVEPORT, LA
ZIP 71104
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Facility Phone Number: 318 227-1163

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1598804486

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	19D0723122
LAB Type	Ambulatory Surgery Center
Facility Name	SHREVEPORT SURGERY CENTER
Street	745 OLIVE STREET SUITE 100
City	SHREVEPORT
State	LA
ZIP	71104
Phone	318 227-1163
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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