25D2136876 CLIA NUMBER - UROLOGIC AMBULATORY SURGERY CENTER LLC

Laboratory Demographics

  • CLIA Code: 25D2136876
  • Facility Name: UROLOGIC AMBULATORY SURGERY CENTER LLC
  • Facility Address: 499 GLOSTER CREEK VLG STE B8
    TUPELO, MS
    ZIP 38801
  • Facility Phone: 662 432-0700
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: DR. JONATHAN KALISH
  • NPI Number: 1154867562
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D2136876
LAB Type Ambulatory Surgery Center
Facility Name UROLOGIC AMBULATORY SURGERY CENTER LLC
Street 499 GLOSTER CREEK VLG STE B8
City TUPELO
State MS
ZIP 38801
Phone 662 432-0700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/18/2025
Certificate Expiration Date 9/17/2027
Facility Type Ambulatory Surgery Center
Lab Director DR. JONATHAN KALISH

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