39D1016119 CLIA NUMBER - KEYSTONE SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 39D1016119
  • Facility Name: KEYSTONE SURGERY CENTER
  • Facility Address: 575 EAST NORWEGIAN STREET
    POTTSVILLE, PA
    ZIP 17901
  • Facility Phone: 570 622-2900
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: ROBERT M. KIMMEL MD
  • NPI Number: 1679544290
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 39D1016119
LAB Type Ambulatory Surgery Center
Facility Name KEYSTONE SURGERY CENTER
Street 575 EAST NORWEGIAN STREET
City POTTSVILLE
State PA
ZIP 17901
Phone 570 622-2900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/20/2025
Certificate Expiration Date 8/19/2027
Facility Type Ambulatory Surgery Center
Lab Director ROBERT M. KIMMEL MD

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