01D0300393 CLIA NUMBER - COOSA VALLEY UROLOGY

Laboratory Demographics

  • Code: 01D0300393
  • Facility Name: COOSA VALLEY UROLOGY
  • Facility Address: 16 SOUTH DOUGLAS AVENUE
    SYLACAUGA, AL
    ZIP 35150
  • Facility Phone: 256 245-2269
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • NPI Number: 1083831804
  • Taxonomy: 174400000X - Specialist
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CLIA Record

Field Name Field Value
CLIA Number 01D0300393
LAB Type Physician Office
Facility Name COOSA VALLEY UROLOGY
Street 16 SOUTH DOUGLAS AVENUE
City SYLACAUGA
State AL
ZIP 35150
Phone 256 245-2269
Certificate Type 4
Certificate Effective Date 8/4/2023
Certificate Expiration Date 8/3/2025
Facility Type Waiver

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