39D0958575 CLIA NUMBER - MAIN LINE SURGERY CENTER LLC

Laboratory Demographics

  • CLIA Code: 39D0958575
  • Facility Name: MAIN LINE SURGERY CENTER LLC
  • Facility Address: 10 PRESIDENTIAL BOULEVARD SUITE 200
    BALA CYNWYD, PA
    ZIP 19004
  • Facility Phone: 610 949-9066
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: RICHARD TIPPERMAN
  • NPI Number: 1184678682
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 39D0958575
LAB Type Ambulatory Surgery Center
Facility Name MAIN LINE SURGERY CENTER LLC
Street 10 PRESIDENTIAL BOULEVARD SUITE 200
City BALA CYNWYD
State PA
ZIP 19004
Phone 610 949-9066
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/6/2024
Certificate Expiration Date 6/5/2026
Facility Type Ambulatory Surgery Center
Lab Director RICHARD TIPPERMAN

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This page was last updated on: 9/29/2025