29D2325993 CLIA NUMBER - GREAT BASIN SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 29D2325993
  • Facility Name: GREAT BASIN SURGERY CENTER
  • Facility Address: 5411 KIETZKE LANE STE 100
    RENO, NV
    ZIP 89511
  • Facility Phone: 805 679-6706
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: TRAVIS KIECKBUSCH
  • NPI Number: 1114700770
  • Taxonomy: 207LP2900X - Anesthesiology

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CLIA Record

Field Name Field Value
CLIA Number 29D2325993
LAB Type Ambulatory Surgery Center
Facility Name GREAT BASIN SURGERY CENTER
Street 5411 KIETZKE LANE STE 100
City RENO
State NV
ZIP 89511
Phone 805 679-6706
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/24/2025
Certificate Expiration Date 6/23/2027
Facility Type Ambulatory Surgery Center
Lab Director TRAVIS KIECKBUSCH

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This page was last updated on: 9/29/2025