21D0950079 CLIA NUMBER - PINEY ORCHARD SURGERY CENTER LLC

Laboratory Demographics

CLIA Number: 21D0950079

Facility Name: PINEY ORCHARD SURGERY CENTER LLC

Facility Address:
1132 ANNAPOLIS ROAD SUITE 103
ODENTON, MD
ZIP 21113
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Facility Phone Number: 410 674-0020

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1780618801

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	21D0950079
LAB Type	Ambulatory Surgery Center
Facility Name	PINEY ORCHARD SURGERY CENTER LLC
Street	1132 ANNAPOLIS ROAD SUITE 103
City	ODENTON
State	MD
ZIP	21113
Phone	410 674-0020
CertificateType	4
CertificateEffectiveDate	8/18/2022
CertificateExpirationDate	8/17/2024
FacilityType	Waiver

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