02D1097182 CLIA NUMBER - SOUTHEAST ALASKA UROLOGY, LLC

Laboratory Demographics

CLIA Number: 02D1097182

Facility Name: SOUTHEAST ALASKA UROLOGY, LLC

Facility Address:
3000 VINTAGE BLVD, STE 270
JUNEAU, AK
ZIP 99801
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Facility Phone Number: 907 458-0700

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1932645512

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	02D1097182
LAB Type	Physician Office
Facility Name	SOUTHEAST ALASKA UROLOGY, LLC
Street	3000 VINTAGE BLVD, STE 270
City	JUNEAU
State	AK
ZIP	99801
Phone	907 458-0700
CertificateType	3
CertificateEffectiveDate	3/19/2023
CertificateExpirationDate	3/18/2025
FacilityType	PPMP

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