28D1079884 CLIA NUMBER - LAKESIDE ENDOSCOPY CENTER LLC

Laboratory Demographics

CLIA Number: 28D1079884

Facility Name: LAKESIDE ENDOSCOPY CENTER LLC

Facility Address:
17001 LAKESIDE HILLS PLAZA SUITE 201
OMAHA, NE
ZIP 68130
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Facility Phone Number: 402 614-2300

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1407992241

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	28D1079884
LAB Type	Ambulatory Surgery Center
Facility Name	LAKESIDE ENDOSCOPY CENTER LLC
Street	17001 LAKESIDE HILLS PLAZA SUITE 201
City	OMAHA
State	NE
ZIP	68130
Phone	402 614-2300
CertificateType	4
CertificateEffectiveDate	2/8/2024
CertificateExpirationDate	2/7/2026
FacilityType	Waiver

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