53D1017128 CLIA NUMBER - POWDER RIVER SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 53D1017128
  • Facility Name: POWDER RIVER SURGERY CENTER
  • Facility Address: 906 WEST SIXTH STREET SUITE C
    GILLETTE, WY
    ZIP 82716
  • Facility Phone: 307 696-8240
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: LINDA BEDWELL
  • NPI Number: 1780738153
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 53D1017128
LAB Type Ambulatory Surgery Center
Facility Name POWDER RIVER SURGERY CENTER
Street 906 WEST SIXTH STREET SUITE C
City GILLETTE
State WY
ZIP 82716
Phone 307 696-8240
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/17/2025
Certificate Expiration Date 9/16/2027
Facility Type Ambulatory Surgery Center
Lab Director LINDA BEDWELL

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This page was last updated on: 9/29/2025