21D0893968 CLIA NUMBER - FREDERICK SURGICAL CENTER

Laboratory Demographics

CLIA Number: 21D0893968

Facility Name: FREDERICK SURGICAL CENTER

Facility Address:
45 THOMAS JOHNSON DRIVE STE 207
FREDERICK, MD
ZIP 21702
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Facility Phone Number: 301 694-3400

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1376542076

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	21D0893968
LAB Type	Ambulatory Surgery Center
Facility Name	FREDERICK SURGICAL CENTER
Street	45 THOMAS JOHNSON DRIVE STE 207
City	FREDERICK
State	MD
ZIP	21702
Phone	301 694-3400
CertificateType	4
CertificateEffectiveDate	11/2/2022
CertificateExpirationDate	11/1/2024
FacilityType	Waiver

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