36D1104951 CLIA NUMBER - LEGACY SURGERY CENTER

Laboratory Demographics

CLIA Number: 36D1104951

Facility Name: LEGACY SURGERY CENTER

Facility Address:
5035 MAYFIELD ROAD SUITE 100
LYNDHURST, OH
ZIP 44124
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Facility Phone Number: 216 923-0666

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1396077582

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	36D1104951
LAB Type	Ambulatory Surgery Center
Facility Name	LEGACY SURGERY CENTER
Street	5035 MAYFIELD ROAD SUITE 100
City	LYNDHURST
State	OH
ZIP	44124
Phone	216 923-0666
CertificateType	4
CertificateEffectiveDate	9/14/2023
CertificateExpirationDate	9/13/2025
FacilityType	Waiver

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