24D2124631 CLIA NUMBER - EAGAN SURGERY CENTER

Laboratory Demographics

CLIA Number: 24D2124631

Facility Name: EAGAN SURGERY CENTER

Facility Address:
2620 EAGAN WOODS DRIVE SUITE 300
EAGAN, MN
ZIP 55121
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Facility Phone Number: 651 968-5639

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1164870895

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	24D2124631
LAB Type	Ambulatory Surgery Center
Facility Name	EAGAN SURGERY CENTER
Street	2620 EAGAN WOODS DRIVE SUITE 300
City	EAGAN
State	MN
ZIP	55121
Phone	651 968-5639
CertificateType	4
CertificateEffectiveDate	1/23/2023
CertificateExpirationDate	1/22/2025
FacilityType	Waiver

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