27D0992739 CLIA NUMBER - MISSOULA BONE & JOINT SURGERY CENTER

Laboratory Demographics

CLIA Number: 27D0992739

Facility Name: MISSOULA BONE & JOINT SURGERY CENTER

Facility Address:
2360 MULLAN ROAD, SUITE B
MISSOULA, MT
ZIP 59802
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Facility Phone Number: 406 542-9695

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1639126303

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	27D0992739
LAB Type	Ambulatory Surgery Center
Facility Name	MISSOULA BONE & JOINT SURGERY CENTER
Street	2360 MULLAN ROAD, SUITE B
City	MISSOULA
State	MT
ZIP	59802
Phone	406 542-9695
CertificateType	4
CertificateEffectiveDate	10/24/2023
CertificateExpirationDate	10/23/2025
FacilityType	Waiver

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