44D1029640 CLIA NUMBER - RIDGE LAKE AMBULATORY SURGERY CENTER

Laboratory Demographics

CLIA Number: 44D1029640

Facility Name: RIDGE LAKE AMBULATORY SURGERY CENTER

Facility Address:
825 RIDGE LAKE BLVD
MEMPHIS, TN
ZIP 38120
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Facility Phone Number: 901 685-2200

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1790844132

Taxonomy: 261QS0132X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	44D1029640
LAB Type	Ambulatory Surgery Center
Facility Name	RIDGE LAKE AMBULATORY SURGERY CENTER
Street	825 RIDGE LAKE BLVD
City	MEMPHIS
State	TN
ZIP	38120
Phone	901 685-2200
CertificateType	4
CertificateEffectiveDate	8/20/2022
CertificateExpirationDate	8/19/2024
FacilityType	Waiver

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