10D1082520 CLIA NUMBER - ADVANCED UROLOGY INSTITUTE

Laboratory Demographics

CLIA Number: 10D1082520

Facility Name: ADVANCED UROLOGY INSTITUTE

Facility Address:
1620 MASON AVE
DAYTONA BEACH, FL
ZIP 32114
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Facility Phone Number: 386 239-8500

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1659726248

Taxonomy: 332900000X - Non-Pharmacy Dispensing Site
A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)

CLIA Record

Field Name	Field Value
CLIA Number	10D1082520
LAB Type	Physician Office
Facility Name	ADVANCED UROLOGY INSTITUTE
Street	1620 MASON AVE
City	DAYTONA BEACH
State	FL
ZIP	32114
Phone	386 239-8500
CertificateType	3
CertificateEffectiveDate	4/11/2024
CertificateExpirationDate	4/10/2026
FacilityType	PPMP

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