Department of Health & Human Services

Centers for Medicare & Medicaid Services
Form Approved

OMB No. 0938-0391

Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number 01C0001000 (X3) Date Survey Completed 11/16/2023
Name of Provider or Supplier Montgomery Surgical Center Llc Street Address, City, State 470 Taylor Road, Montgomery, AL
For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency.
(X4) ID Prefix Tag Summary Statement of Deficiencies

(Each deficiency should be preceded by full regulatory or LSC identifying information)
Q0000 A recertification survey was conducted at Montgomery Surgery Center, LLC on 11/14/23 to 11/16/23. An acceptable plan of correction is required for standard level deficient findings.