39D1067509 CLIA NUMBER - GATEWAY SURGERY CENTER LLC

Laboratory Demographics

  • CLIA Code: 39D1067509
  • Facility Name: GATEWAY SURGERY CENTER LLC
  • Facility Address: 494 NORTHAMPTON ST SUITE 2
    EDWARDSVILLE, PA
    ZIP 18704
  • Facility Phone: 570 288-8100
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: DR. CHARLES J. SCROBOLA
  • NPI Number: 1871804815
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 39D1067509
LAB Type Ambulatory Surgery Center
Facility Name GATEWAY SURGERY CENTER LLC
Street 494 NORTHAMPTON ST SUITE 2
City EDWARDSVILLE
State PA
ZIP 18704
Phone 570 288-8100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/19/2025
Certificate Expiration Date 4/18/2027
Facility Type Ambulatory Surgery Center
Lab Director DR. CHARLES J. SCROBOLA

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