21D2107472 CLIA NUMBER - JEV SURGERY CENTER

Laboratory Demographics

CLIA Number: 21D2107472

Facility Name: JEV SURGERY CENTER

Facility Address:
4 PARK CENTER COURT STE 100
OWINGS MILLS, MD
ZIP 21117
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Facility Phone Number: 410 484-8860

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1154951945

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	21D2107472
LAB Type	Ambulatory Surgery Center
Facility Name	JEV SURGERY CENTER
Street	4 PARK CENTER COURT STE 100
City	OWINGS MILLS
State	MD
ZIP	21117
Phone	410 484-8860
CertificateType	4
CertificateEffectiveDate	1/14/2024
CertificateExpirationDate	1/13/2026
FacilityType	Waiver

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