01D2086760 CLIA NUMBER - BRIDGEWAY DIAGNOSTIC RADIOLOGY, LLC

Laboratory Demographics

  • CLIA Code: 01D2086760
  • Facility Name: BRIDGEWAY DIAGNOSTIC RADIOLOGY, LLC
  • Facility Address: 5007 SUMMERVILLE ROAD
    PHENIX CITY, AL
    ZIP 36867
  • Facility Phone: 334 323-3937
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: DR. JASON HOOVER
  • NPI Number: 1306248729
  • Taxonomy: 2085R0202X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 01D2086760
LAB Type Practitioner Other
Facility Name BRIDGEWAY DIAGNOSTIC RADIOLOGY, LLC
Street 5007 SUMMERVILLE ROAD
City PHENIX CITY
State AL
ZIP 36867
Phone 334 323-3937
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/12/2024
Certificate Expiration Date 11/11/2026
Facility Type Practitioner Other
Lab Director DR. JASON HOOVER

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