44D1051912 CLIA NUMBER - HOLSTON VALLEY AMBULATORY SURGERY CENTER

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Laboratory Demographics

CLIA Number: 44D1051912

Facility Name: HOLSTON VALLEY AMBULATORY SURGERY CENTER

Facility Address:
103 WEST STONE DRIVE
KINGSPORT, TN
ZIP 37660
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Facility Phone Number: 423 224-4910

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1356396857

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	44D1051912
LAB Type	Ambulatory Surgery Center
Facility Name	HOLSTON VALLEY AMBULATORY SURGERY CENTER
Street	103 WEST STONE DRIVE
City	KINGSPORT
State	TN
ZIP	37660
Phone	423 224-4910
CertificateType	4
CertificateEffectiveDate	3/14/2024
CertificateExpirationDate	3/13/2026
FacilityType	Waiver

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