01D2123209 CLIA NUMBER - MTN LAKE UROLOGY PC

Laboratory Demographics

  • CLIA Code: 01D2123209
  • Facility Name: MTN LAKE UROLOGY PC
  • Facility Address: 750 BYRON ROAD
    SCOTTSBORO, AL
    ZIP 35769
  • Facility Phone: 256 259-8765
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: MICHAEL G. SIMMONS MD
  • NPI Number: 1801050364
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 01D2123209
LAB Type Physician Office
Facility Name MTN LAKE UROLOGY PC
Street 750 BYRON ROAD
City SCOTTSBORO
State AL
ZIP 35769
Phone 256 259-8765
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 12/14/2024
Certificate Expiration Date 12/13/2026
Facility Type Physician Office
Lab Director MICHAEL G. SIMMONS MD

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