28D1053164 CLIA NUMBER - LAKESIDE AMBULATORY SURGICAL CENTER LLC

Laboratory Demographics

CLIA Number: 28D1053164

Facility Name: LAKESIDE AMBULATORY SURGICAL CENTER LLC

Facility Address:
17030 LAKESIDE HILLS DRIVE, SUITE 110
OMAHA, NE
ZIP 68130
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Facility Phone Number: 402 758-5220

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1528026788

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	28D1053164
LAB Type	Ambulatory Surgery Center
Facility Name	LAKESIDE AMBULATORY SURGICAL CENTER LLC
Street	17030 LAKESIDE HILLS DRIVE, SUITE 110
City	OMAHA
State	NE
ZIP	68130
Phone	402 758-5220
CertificateType	4
CertificateEffectiveDate	4/17/2024
CertificateExpirationDate	4/16/2026
FacilityType	Waiver

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