01D2164364 CLIA NUMBER - LABORATORY CORPORATION OF AMERICA HOLDINGS

Laboratory Demographics

  • CLIA Code: 01D2164364
  • Facility Name: LABORATORY CORPORATION OF AMERICA HOLDINGS
  • Facility Address: 129 MITYLENE PARK LANE
    MONTGOMERY, AL
    ZIP 36117
  • Facility Phone: 334 851-8693
  • Facility Type: Independent
  • Facility Type: Waiver
  • Lab Director: JESSE MONTGOMERY
  • NPI Number: 1861012361
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 01D2164364
LAB Type Independent
Facility Name LABORATORY CORPORATION OF AMERICA HOLDINGS
Street 129 MITYLENE PARK LANE
City MONTGOMERY
State AL
ZIP 36117
Phone 334 851-8693
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/3/2025
Certificate Expiration Date 4/2/2027
Facility Type Independent
Lab Director JESSE MONTGOMERY

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