25D1019505 CLIA NUMBER - LAUREL SURGERY AND ENDOSCOPY CENTER LLC

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Laboratory Demographics

CLIA Number: 25D1019505

Facility Name: LAUREL SURGERY AND ENDOSCOPY CENTER LLC

Facility Address:
1710 WEST 12TH STREET
LAUREL, MS
ZIP 39440
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Facility Phone Number: 601 369-2021

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1689605826

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	25D1019505
LAB Type	Ambulatory Surgery Center
Facility Name	LAUREL SURGERY AND ENDOSCOPY CENTER LLC
Street	1710 WEST 12TH STREET
City	LAUREL
State	MS
ZIP	39440
Phone	601 369-2021
CertificateType	4
CertificateEffectiveDate	11/20/2023
CertificateExpirationDate	11/19/2025
FacilityType	Waiver

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