21D2029564 CLIA NUMBER - LEONARDTOWN SURGERY CENTER, LLC

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Laboratory Demographics

CLIA Number: 21D2029564

Facility Name: LEONARDTOWN SURGERY CENTER, LLC

Facility Address:
40900 MERCHANTS LANE
LEONARDTOWN, MD
ZIP 20650
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Facility Phone Number: 301 690-2203

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1174802045

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	21D2029564
LAB Type	Ambulatory Surgery Center
Facility Name	LEONARDTOWN SURGERY CENTER, LLC
Street	40900 MERCHANTS LANE
City	LEONARDTOWN
State	MD
ZIP	20650
Phone	301 690-2203
CertificateType	4
CertificateEffectiveDate	9/9/2023
CertificateExpirationDate	9/8/2025
FacilityType	Waiver

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