53D2036482 CLIA NUMBER - PREMIER SURGICAL CENTER, LLC

Laboratory Demographics

  • CLIA Code: 53D2036482
  • Facility Name: PREMIER SURGICAL CENTER, LLC
  • Facility Address: 195 OVERTHRUST ROAD
    EVANSTON, WY
    ZIP 82930
  • Facility Phone: 307 444-3600
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: JASON HAACK
  • NPI Number: 1417228370
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 53D2036482
LAB Type Ambulatory Surgery Center
Facility Name PREMIER SURGICAL CENTER, LLC
Street 195 OVERTHRUST ROAD
City EVANSTON
State WY
ZIP 82930
Phone 307 444-3600
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/8/2024
Certificate Expiration Date 2/7/2026
Facility Type Ambulatory Surgery Center
Lab Director JASON HAACK

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