21D0978653 CLIA NUMBER - SUMMIT AMBULATORY SURGICAL CENTER

Laboratory Demographics

CLIA Number: 21D0978653

Facility Name: SUMMIT AMBULATORY SURGICAL CENTER

Facility Address:
12435 PARK POTOMAC AVE SUITE 410
POTOMAC, MD
ZIP 20854
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Facility Phone Number: 301 309-8219

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1649707324

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	21D0978653
LAB Type	Ambulatory Surgery Center
Facility Name	SUMMIT AMBULATORY SURGICAL CENTER
Street	12435 PARK POTOMAC AVE SUITE 410
City	POTOMAC
State	MD
ZIP	20854
Phone	301 309-8219
CertificateType	4
CertificateEffectiveDate	9/29/2022
CertificateExpirationDate	9/28/2024
FacilityType	Waiver

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