28D2051578 CLIA NUMBER - PACIFIC SURGERY CENTER, LLC

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Laboratory Demographics

CLIA Number: 28D2051578

Facility Name: PACIFIC SURGERY CENTER, LLC

Facility Address:
10707 PACIFIC STREET, SUITE 100
OMAHA, NE
ZIP 68114
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Facility Phone Number: 605 496-2785

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1720334097

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	28D2051578
LAB Type	Ambulatory Surgery Center
Facility Name	PACIFIC SURGERY CENTER, LLC
Street	10707 PACIFIC STREET, SUITE 100
City	OMAHA
State	NE
ZIP	68114
Phone	605 496-2785
CertificateType	4
CertificateEffectiveDate	12/20/2022
CertificateExpirationDate	12/19/2024
FacilityType	Waiver

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