45D2143209 CLIA NUMBER - MONTFORT SURGERY CENTER LLC

Laboratory Demographics

CLIA Number: 45D2143209

Facility Name: MONTFORT SURGERY CENTER LLC

Facility Address:
5220 LBJ FREEWAY SUITE 150
DALLAS, TX
ZIP 75240
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Facility Phone Number: 972 636-5727

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1437664406

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D2143209
LAB Type	Ambulatory Surgery Center
Facility Name	MONTFORT SURGERY CENTER LLC
Street	5220 LBJ FREEWAY SUITE 150
City	DALLAS
State	TX
ZIP	75240
Phone	972 636-5727
CertificateType	4
CertificateEffectiveDate	1/25/2024
CertificateExpirationDate	1/24/2026
FacilityType	Waiver

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