23D2184469 CLIA NUMBER - UPPER PENINSULA SURGERY CENTER

Laboratory Demographics

CLIA Number: 23D2184469

Facility Name: UPPER PENINSULA SURGERY CENTER

Facility Address:
1414 W FAIR AVENUE SUITE 235
MARQUETTE, MI
ZIP 49855
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Facility Phone Number: 906 273-2223

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1619252442

Taxonomy: 2085R0202X - Radiology
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

CLIA Record

Field Name	Field Value
CLIA Number	23D2184469
LAB Type	Ambulatory Surgery Center
Facility Name	UPPER PENINSULA SURGERY CENTER
Street	1414 W FAIR AVENUE SUITE 235
City	MARQUETTE
State	MI
ZIP	49855
Phone	906 273-2223
CertificateType	4
CertificateEffectiveDate	5/20/2022
CertificateExpirationDate	5/19/2024
FacilityType	Waiver

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