21D2319601 CLIA NUMBER - AG LAB SERVICE LLC

Laboratory Demographics

  • CLIA Code: 21D2319601
  • Facility Name: AG LAB SERVICE LLC
  • Facility Address: 137 LOG CANOE CIR
    STEVENSVILLE, MD
    ZIP 21666
  • Facility Phone: 443 249-3405
  • Facility Type: Independent
  • Facility Type: Waiver
  • Lab Director: GARY SPROUSE
  • NPI Number: 1871355446
  • Taxonomy: 246RP1900X - Technician, Pathology

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CLIA Record

Field Name Field Value
CLIA Number 21D2319601
LAB Type Independent
Facility Name AG LAB SERVICE LLC
Street 137 LOG CANOE CIR
City STEVENSVILLE
State MD
ZIP 21666
Phone 443 249-3405
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/4/2025
Certificate Expiration Date 3/3/2027
Facility Type Independent
Lab Director GARY SPROUSE

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