30D2245258 CLIA NUMBER - COASTAL SURGICAL CENTER, LLC

Laboratory Demographics

CLIA Number: 30D2245258

Facility Name: COASTAL SURGICAL CENTER, LLC

Facility Address:
291 SHATTUCK WAY
NEWINGTON, NH
ZIP 03801
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Facility Phone Number: 603 314-8035

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1336713890

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	30D2245258
LAB Type	Ambulatory Surgery Center
Facility Name	COASTAL SURGICAL CENTER, LLC
Street	291 SHATTUCK WAY
City	NEWINGTON
State	NH
ZIP	03801
Phone	603 314-8035
CertificateType	4
CertificateEffectiveDate	12/10/2023
CertificateExpirationDate	12/9/2025
FacilityType	Waiver

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