50D1051084 CLIA NUMBER - PACIFIC SURGICAL CENTER

Laboratory Demographics

CLIA Number: 50D1051084

Facility Name: PACIFIC SURGICAL CENTER

Facility Address:
625 9TH AVE
LONGVIEW, WA
ZIP 98632
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Facility Phone Number: 360 442-7900

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1750481453

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	50D1051084
LAB Type	Ambulatory Surgery Center
Facility Name	PACIFIC SURGICAL CENTER
Street	625 9TH AVE
City	LONGVIEW
State	WA
ZIP	98632
Phone	360 442-7900
CertificateType	4
CertificateEffectiveDate	2/21/2006
CertificateExpirationDate	4/4/2028
FacilityType	Waiver

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