45D2093694 CLIA NUMBER - BLUEBONNET SURGERY PAVILION

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Laboratory Demographics

CLIA Number: 45D2093694

Facility Name: BLUEBONNET SURGERY PAVILION

Facility Address:
1324 BROWN STREET, SUITE 600
WAXAHACHIE, TX
ZIP 75165
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Facility Phone Number: 972 937-4000

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1639561640

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D2093694
LAB Type	Ambulatory Surgery Center
Facility Name	BLUEBONNET SURGERY PAVILION
Street	1324 BROWN STREET, SUITE 600
City	WAXAHACHIE
State	TX
ZIP	75165
Phone	972 937-4000
CertificateType	4
CertificateEffectiveDate	4/2/2023
CertificateExpirationDate	4/1/2025
FacilityType	Waiver

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