49D1015712 CLIA NUMBER - ROANOKE AMBULATORY SURGERY CENTER

Laboratory Demographics

CLIA Number: 49D1015712

Facility Name: ROANOKE AMBULATORY SURGERY CENTER

Facility Address:
1102 JEFFERSON STREET, SE
ROANOKE, VA
ZIP 24016
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Facility Phone Number: 540 342-0707

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1013914985

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	49D1015712
LAB Type	Physician Office
Facility Name	ROANOKE AMBULATORY SURGERY CENTER
Street	1102 JEFFERSON STREET, SE
City	ROANOKE
State	VA
ZIP	24016
Phone	540 342-0707
CertificateType	4
CertificateEffectiveDate	8/12/2023
CertificateExpirationDate	8/11/2025
FacilityType	Waiver

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