34D2171507 CLIA NUMBER - SOUTHERN SURGICAL OUTPATIENT SURGERY CENTER

Laboratory Demographics

CLIA Number: 34D2171507

Facility Name: SOUTHERN SURGICAL OUTPATIENT SURGERY CENTER

Facility Address:
2457 EMERALD PLACE
GREENVILLE, NC
ZIP 27834
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Facility Phone Number: 252 758-2224

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1861038606

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	34D2171507
LAB Type	Physician Office
Facility Name	SOUTHERN SURGICAL OUTPATIENT SURGERY CENTER
Street	2457 EMERALD PLACE
City	GREENVILLE
State	NC
ZIP	27834
Phone	252 758-2224
CertificateType	4
CertificateEffectiveDate	9/3/2023
CertificateExpirationDate	9/2/2025
FacilityType	Waiver

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