39D1017998 CLIA NUMBER - MAIN LINE ENCOSCOPY CENTER BALA CYNWYD

Laboratory Demographics

CLIA Number: 39D1017998

Facility Name: MAIN LINE ENCOSCOPY CENTER BALA CYNWYD

Facility Address:
333 E CITY LINE AVENUE, SUITE IL 30 2 BALA PLAZA
BALA CYNWYD, PA
ZIP 19004
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Facility Phone Number: 610 660-8470

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1184678682

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	39D1017998
LAB Type	Ambulatory Surgery Center
Facility Name	MAIN LINE ENCOSCOPY CENTER BALA CYNWYD
Street	333 E CITY LINE AVENUE, SUITE IL 30 2 BALA PLAZA
City	BALA CYNWYD
State	PA
ZIP	19004
Phone	610 660-8470
CertificateType	4
CertificateEffectiveDate	10/10/2023
CertificateExpirationDate	10/9/2025
FacilityType	Waiver

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