46D2236698 CLIA NUMBER - LOGAN SURGERY CENTER, LLC

Laboratory Demographics

CLIA Number: 46D2236698

Facility Name: LOGAN SURGERY CENTER, LLC

Facility Address:
1350 NORTH 500 EAST
LOGAN, UT
ZIP 84341
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Facility Phone Number: 801 507-9967

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1063082980

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	46D2236698
LAB Type	Ambulatory Surgery Center
Facility Name	LOGAN SURGERY CENTER, LLC
Street	1350 NORTH 500 EAST
City	LOGAN
State	UT
ZIP	84341
Phone	801 507-9967
CertificateType	4
CertificateEffectiveDate	9/20/2023
CertificateExpirationDate	9/19/2025
FacilityType	Waiver

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