19D1106904 CLIA NUMBER - SOUTHERN UROLOGY

Laboratory Demographics

  • CLIA Code: 19D1106904
  • Facility Name: SOUTHERN UROLOGY
  • Facility Address: 120 RUE LOUIS XIV BLDG #2, ATTN MIKE FONTENOT
    LAFAYETTE, LA
    ZIP 70508
  • Facility Phone: 337 233-6665
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: ZOLTAN GOMBOS
  • NPI Number: 1760612865
  • Taxonomy: 208800000X - Urology

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CLIA Record

Field Name Field Value
CLIA Number 19D1106904
LAB Type Physician Office
Facility Name SOUTHERN UROLOGY
Street 120 RUE LOUIS XIV BLDG #2, ATTN MIKE FONTENOT
City LAFAYETTE
State LA
ZIP 70508
Phone 337 233-6665
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 11/15/2024
Certificate Expiration Date 11/14/2026
Facility Type Physician Office
Lab Director ZOLTAN GOMBOS

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