44D2003462 CLIA NUMBER - VAN DYCK ASC, LLC

Laboratory Demographics

  • CLIA Code: 44D2003462
  • Facility Name: VAN DYCK ASC, LLC
  • Facility Address: 1024 KELLEY DRIVE
    PARIS, TN
    ZIP 38242
  • Facility Phone: 731 642-5003
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: JAMES C. LODEN
  • NPI Number: 1760414056
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 44D2003462
LAB Type Ambulatory Surgery Center
Facility Name VAN DYCK ASC, LLC
Street 1024 KELLEY DRIVE
City PARIS
State TN
ZIP 38242
Phone 731 642-5003
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/10/2024
Certificate Expiration Date 2/9/2026
Facility Type Ambulatory Surgery Center
Lab Director JAMES C. LODEN

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