46D2156197 CLIA NUMBER - LOGAN SURGICAL SUITES, LLC

Laboratory Demographics

CLIA Number: 46D2156197

Facility Name: LOGAN SURGICAL SUITES, LLC

Facility Address:
55 EAST GOLF COURSE ROAD
LOGAN, UT
ZIP 84321
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Facility Phone Number: 435 787-7190

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1104301613

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	46D2156197
LAB Type	Ambulatory Surgery Center
Facility Name	LOGAN SURGICAL SUITES, LLC
Street	55 EAST GOLF COURSE ROAD
City	LOGAN
State	UT
ZIP	84321
Phone	435 787-7190
CertificateType	4
CertificateEffectiveDate	10/11/2022
CertificateExpirationDate	10/10/2024
FacilityType	Waiver

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