39D2184024 CLIA NUMBER - MIDLANTIC UROLOGY SURGERY CENTER LLC

Laboratory Demographics

CLIA Number: 39D2184024

Facility Name: MIDLANTIC UROLOGY SURGERY CENTER LLC

Facility Address:
656 EAST SWEDESFORD ROAD, SUITE 100
WAYNE, PA
ZIP 19087
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Facility Phone Number: 610 273-5320

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1811534555

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	39D2184024
LAB Type	Ambulatory Surgery Center
Facility Name	MIDLANTIC UROLOGY SURGERY CENTER LLC
Street	656 EAST SWEDESFORD ROAD, SUITE 100
City	WAYNE
State	PA
ZIP	19087
Phone	610 273-5320
CertificateType	4
CertificateEffectiveDate	5/14/2024
CertificateExpirationDate	5/13/2026
FacilityType	Waiver

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