34D0695071 CLIA NUMBER - BLUE MOUNTAIN UROLOGY

Laboratory Demographics

  • CLIA Code: 34D0695071
  • Facility Name: BLUE MOUNTAIN UROLOGY
  • Facility Address: 15 BRETTWOOD TRACE
    CLYDE, NC
    ZIP 28721
  • Facility Phone: (828) 452-9700
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LUKE BIDIKOV
  • NPI Number: 1134149990
  • Taxonomy: 208800000X - Urology

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CLIA Record

Field Name Field Value
CLIA Number 34D0695071
LAB Type Physician Office
Facility Name BLUE MOUNTAIN UROLOGY
Street 15 BRETTWOOD TRACE
City CLYDE
State NC
ZIP 28721
Phone 8284529700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/1/2026
Certificate Expiration Date 12/31/2027
Facility Type Physician Office
Lab Director LUKE BIDIKOV

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This page was last updated on: 5/18/2026