39D2322697 CLIA NUMBER - REVAMP HEART & VASCULAR SURGERY CTR

Laboratory Demographics

  • CLIA Code: 39D2322697
  • Facility Name: REVAMP HEART & VASCULAR SURGERY CTR
  • Facility Address: 510 N BROAD ST, STE 201
    PHILADELPHIA, PA
    ZIP 19130
  • Facility Phone: 267 908-9520
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: DR. JON C. GEORGE
  • NPI Number: 1962245076
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 39D2322697
LAB Type Ambulatory Surgery Center
Facility Name REVAMP HEART & VASCULAR SURGERY CTR
Street 510 N BROAD ST, STE 201
City PHILADELPHIA
State PA
ZIP 19130
Phone 267 908-9520
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/25/2025
Certificate Expiration Date 4/24/2027
Facility Type Ambulatory Surgery Center
Lab Director DR. JON C. GEORGE

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