36D1023998 CLIA NUMBER - REVISION ADVANCED SURGERY CENTER

Laboratory Demographics

CLIA Number: 36D1023998

Facility Name: REVISION ADVANCED SURGERY CENTER

Facility Address:
240 WEST COOK ROAD
MANSFIELD, OH
ZIP 44907
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Facility Phone Number: 419 525-3737

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1881695732

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	36D1023998
LAB Type	Ambulatory Surgery Center
Facility Name	REVISION ADVANCED SURGERY CENTER
Street	240 WEST COOK ROAD
City	MANSFIELD
State	OH
ZIP	44907
Phone	419 525-3737
CertificateType	4
CertificateEffectiveDate	3/31/2024
CertificateExpirationDate	3/30/2026
FacilityType	Waiver

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