36D2125616 CLIA NUMBER - GYPSY LANE ENDOSCOPY SUITES, INC

Laboratory Demographics

CLIA Number: 36D2125616

Facility Name: GYPSY LANE ENDOSCOPY SUITES, INC

Facility Address:
630 GYPSY LANE
YOUNGSTOWN, OH
ZIP 44505
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Facility Phone Number: 330 399-7215

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1730614330

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	36D2125616
LAB Type	Ambulatory Surgery Center
Facility Name	GYPSY LANE ENDOSCOPY SUITES, INC
Street	630 GYPSY LANE
City	YOUNGSTOWN
State	OH
ZIP	44505
Phone	330 399-7215
CertificateType	4
CertificateEffectiveDate	2/10/2023
CertificateExpirationDate	2/9/2025
FacilityType	Waiver

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