24D0980654 CLIA NUMBER - PAVILION SURGERY CENTER

Laboratory Demographics

CLIA Number: 24D0980654

Facility Name: PAVILION SURGERY CENTER

Facility Address:
920 EAST 1ST ST SUITE 101
DULUTH, MN
ZIP 55805
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Facility Phone Number: 218 279-6200

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1649223629

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	24D0980654
LAB Type	Ambulatory Surgery Center
Facility Name	PAVILION SURGERY CENTER
Street	920 EAST 1ST ST SUITE 101
City	DULUTH
State	MN
ZIP	55805
Phone	218 279-6200
CertificateType	4
CertificateEffectiveDate	11/29/2022
CertificateExpirationDate	11/28/2024
FacilityType	Waiver

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