27D0934160 CLIA NUMBER - PROVIDENCE SURGERY CENTER

Laboratory Demographics

CLIA Number: 27D0934160

Facility Name: PROVIDENCE SURGERY CENTER

Facility Address:
902 NORTH ORANGE STREET
MISSOULA, MT
ZIP 59802
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Facility Phone Number: (406) 327-3301

Facility Type: AMBULATORY SURGERY CENTER

Certificate Type: Waiver

NPI Number: 1407860745

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	27D0934160
LAB Type	AMBULATORY SURGERY CENTER
Facility Name	PROVIDENCE SURGERY CENTER
Street	902 NORTH ORANGE STREET
City	MISSOULA
State	MT
ZIP	59802
Phone	(406) 327-3301

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This page was last updated on: 5/11/2023