43D1045358 CLIA NUMBER - PLASTIC SURGICAL CENTER

Laboratory Demographics

CLIA Number: 43D1045358

Facility Name: PLASTIC SURGICAL CENTER

Facility Address:
3615 5TH STREET SUITE 100
RAPID CITY, SD
ZIP 57701
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Facility Phone Number: 605 343-6714

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1760465207

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	43D1045358
LAB Type	Ambulatory Surgery Center
Facility Name	PLASTIC SURGICAL CENTER
Street	3615 5TH STREET SUITE 100
City	RAPID CITY
State	SD
ZIP	57701
Phone	605 343-6714
CertificateType	4
CertificateEffectiveDate	9/13/2023
CertificateExpirationDate	9/12/2025
FacilityType	Waiver

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