21D2135313 CLIA NUMBER - LAKEVIEW SURGERY CENTER LLC

Laboratory Demographics

CLIA Number: 21D2135313

Facility Name: LAKEVIEW SURGERY CENTER LLC

Facility Address:
17001 SCIENCE DRIVE SUITE 114
BOWIE, MD
ZIP 20715
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Facility Phone Number: 301 985-2830

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1629429410

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	21D2135313
LAB Type	Ambulatory Surgery Center
Facility Name	LAKEVIEW SURGERY CENTER LLC
Street	17001 SCIENCE DRIVE SUITE 114
City	BOWIE
State	MD
ZIP	20715
Phone	301 985-2830
CertificateType	4
CertificateEffectiveDate	8/21/2023
CertificateExpirationDate	8/20/2025
FacilityType	Waiver

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