26D0713155 CLIA NUMBER - CENTRAL MISSOURI UROLOGY CLINIC

Laboratory Demographics

CLIA Number: 26D0713155

Facility Name: CENTRAL MISSOURI UROLOGY CLINIC

Facility Address:
1428 HWY 72 EAST
ROLLA, MO
ZIP 65401
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Facility Phone Number: 573 364-1014

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1710940630

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	26D0713155
LAB Type	Physician Office
Facility Name	CENTRAL MISSOURI UROLOGY CLINIC
Street	1428 HWY 72 EAST
City	ROLLA
State	MO
ZIP	65401
Phone	573 364-1014
CertificateType	3
CertificateEffectiveDate	11/6/2022
CertificateExpirationDate	11/5/2024
FacilityType	PPMP

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