34D1088764 CLIA NUMBER - CENTERS FOR ADVANCED UROLOGY, LLP, THE

Laboratory Demographics

  • CLIA Code: 34D1088764
  • Facility Name: CENTERS FOR ADVANCED UROLOGY, LLP, THE
  • Facility Address: 110 CAPCOM AVENUE SUITE 201
    WAKE FOREST, NC
    ZIP 27587
  • Facility Phone: 919 758-8677
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARK JALKUT
  • NPI Number: 1659947117
  • Taxonomy: 332900000X - Non-Pharmacy Dispensing Site

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CLIA Record

Field Name Field Value
CLIA Number 34D1088764
LAB Type Physician Office
Facility Name CENTERS FOR ADVANCED UROLOGY, LLP, THE
Street 110 CAPCOM AVENUE SUITE 201
City WAKE FOREST
State NC
ZIP 27587
Phone 919 758-8677
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/15/2025
Certificate Expiration Date 5/14/2027
Facility Type Physician Office
Lab Director MARK JALKUT

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