45D1047715 CLIA NUMBER - MEDICAL VILLAGE SURGERY CENTER

Laboratory Demographics

CLIA Number: 45D1047715

Facility Name: MEDICAL VILLAGE SURGERY CENTER

Facility Address:
2507 MEDICAL ROWE,SUITE 101
GRAND PRAIRIE, TX
ZIP 75051
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Facility Phone Number: 972 647-8520

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1568408201

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D1047715
LAB Type	Ambulatory Surgery Center
Facility Name	MEDICAL VILLAGE SURGERY CENTER
Street	2507 MEDICAL ROWE,SUITE 101
City	GRAND PRAIRIE
State	TX
ZIP	75051
Phone	972 647-8520
CertificateType	4
CertificateEffectiveDate	11/10/2023
CertificateExpirationDate	11/9/2025
FacilityType	Waiver

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