14D1048280 CLIA NUMBER - ADVANCED UROLOGIC SURGEONS

Laboratory Demographics

  • CLIA Code: 14D1048280
  • Facility Name: ADVANCED UROLOGIC SURGEONS
  • Facility Address: 4109 S WATERTOWER PL
    MOUNT VERNON, IL
    ZIP 62864
  • Facility Phone: 618 244-4060
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DAVID R. KNOWLES
  • NPI Number: 1093901340
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 14D1048280
LAB Type Physician Office
Facility Name ADVANCED UROLOGIC SURGEONS
Street 4109 S WATERTOWER PL
City MOUNT VERNON
State IL
ZIP 62864
Phone 618 244-4060
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/29/2023
Certificate Expiration Date 11/28/2025
Facility Type Physician Office
Lab Director DAVID R. KNOWLES

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