21D1102705 CLIA NUMBER - SUMMIT AMBULATORY SURGICAL CENTER LLC

Laboratory Demographics

CLIA Number: 21D1102705

Facility Name: SUMMIT AMBULATORY SURGICAL CENTER LLC

Facility Address:
410 MALCOLM DR SUITE A
WESTMINSTER, MD
ZIP 21157
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Facility Phone Number: 410 876-1633

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1114196151

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	21D1102705
LAB Type	Ambulatory Surgery Center
Facility Name	SUMMIT AMBULATORY SURGICAL CENTER LLC
Street	410 MALCOLM DR SUITE A
City	WESTMINSTER
State	MD
ZIP	21157
Phone	410 876-1633
CertificateType	4
CertificateEffectiveDate	7/23/2023
CertificateExpirationDate	7/22/2025
FacilityType	Waiver

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