29D0945586 CLIA NUMBER - LAKE TAHOE SURGERY CENTER

Laboratory Demographics

CLIA Number: 29D0945586

Facility Name: LAKE TAHOE SURGERY CENTER

Facility Address:
212 ELKS POINT RD STE 201
ZEPHYR COVE, NV
ZIP 89448
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Facility Phone Number: 775 588-9188

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1700963725

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	29D0945586
LAB Type	Ambulatory Surgery Center
Facility Name	LAKE TAHOE SURGERY CENTER
Street	212 ELKS POINT RD STE 201
City	ZEPHYR COVE
State	NV
ZIP	89448
Phone	775 588-9188
CertificateType	4
CertificateEffectiveDate	5/5/2024
CertificateExpirationDate	5/4/2026
FacilityType	Waiver

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