26D1028574 CLIA NUMBER - RIVERSIDE AMBULATORY SURGERY CENTER, LLC DBA ENDOSCOPY & COLONOSCOPY CENTER

Laboratory Demographics

  • CLIA Code: 26D1028574
  • Facility Name: RIVERSIDE AMBULATORY SURGERY CENTER, LLC DBA ENDOSCOPY & COLONOSCOPY CENTER
  • Facility Address: 100 VILLAGE SQUARE
    HAZELWOOD, MO
    ZIP 63042
  • Facility Phone: 314 373-8931
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: GARY KOENIG
  • NPI Number: 1790132322
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 26D1028574
LAB Type Ambulatory Surgery Center
Facility Name RIVERSIDE AMBULATORY SURGERY CENTER, LLC DBA ENDOSCOPY & COLONOSCOPY CENTER
Street 100 VILLAGE SQUARE
City HAZELWOOD
State MO
ZIP 63042
Phone 314 373-8931
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/27/2024
Certificate Expiration Date 7/26/2026
Facility Type Ambulatory Surgery Center
Lab Director GARY KOENIG

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