25D2303873 CLIA NUMBER - SOUTHAVEN SURGERY CENTER, LLC

Laboratory Demographics

  • CLIA Code: 25D2303873
  • Facility Name: SOUTHAVEN SURGERY CENTER, LLC
  • Facility Address: 7600 AIRWAYS BLVD, SUITE C & D
    SOUTHAVEN, MS
    ZIP 38671
  • Facility Phone: 901 747-0040
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: DR. MATTHEW D. KANGAS
  • NPI Number: 1386498848
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D2303873
LAB Type Ambulatory Surgery Center
Facility Name SOUTHAVEN SURGERY CENTER, LLC
Street 7600 AIRWAYS BLVD, SUITE C & D
City SOUTHAVEN
State MS
ZIP 38671
Phone 901 747-0040
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/2/2024
Certificate Expiration Date 5/1/2026
Facility Type Ambulatory Surgery Center
Lab Director DR. MATTHEW D. KANGAS

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This page was last updated on: 9/29/2025