04D2281004 CLIA NUMBER - VITALITY PLUS UROLOGY, LLC

Laboratory Demographics

  • CLIA Code: 04D2281004
  • Facility Name: VITALITY PLUS UROLOGY, LLC
  • Facility Address: 140 HWY 201 NORTH
    MOUNTAIN HOME, AR
    ZIP 72653
  • Facility Phone: 870 232-5215
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: DR. AHSAN SIDDIQI
  • NPI Number: 1790484194
  • Taxonomy: 208800000X - Urology

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CLIA Record

Field Name Field Value
CLIA Number 04D2281004
LAB Type Physician Office
Facility Name VITALITY PLUS UROLOGY, LLC
Street 140 HWY 201 NORTH
City MOUNTAIN HOME
State AR
ZIP 72653
Phone 870 232-5215
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 3/5/2025
Certificate Expiration Date 3/4/2027
Facility Type Physician Office
Lab Director DR. AHSAN SIDDIQI

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