25D2084461 CLIA NUMBER - SPECIALTY SURGERY CENTER, LLC

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Laboratory Demographics

CLIA Number: 25D2084461

Facility Name: SPECIALTY SURGERY CENTER, LLC

Facility Address:
7580 CLARINGTON COVE
SOUTHAVEN, MS
ZIP 38671
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Facility Phone Number: 615 620-9300

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1174938344

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	25D2084461
LAB Type	Ambulatory Surgery Center
Facility Name	SPECIALTY SURGERY CENTER, LLC
Street	7580 CLARINGTON COVE
City	SOUTHAVEN
State	MS
ZIP	38671
Phone	615 620-9300
CertificateType	4
CertificateEffectiveDate	9/24/2022
CertificateExpirationDate	9/23/2024
FacilityType	Waiver

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