44D0954362 CLIA NUMBER - UNIVERSITY PEDIATRIC UROLOGY

Laboratory Demographics

CLIA Number: 44D0954362

Facility Name: UNIVERSITY PEDIATRIC UROLOGY

Facility Address:
2100 CLINCH AVENUE SUITE 120
KNOXVILLE, TN
ZIP 37916
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Facility Phone Number: 865 637-7290

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1386199347

Taxonomy: 335E00000X - Prosthetic/Orthotic Supplier
An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition.

CLIA Record

Field Name	Field Value
CLIA Number	44D0954362
LAB Type	Physician Office
Facility Name	UNIVERSITY PEDIATRIC UROLOGY
Street	2100 CLINCH AVENUE SUITE 120
City	KNOXVILLE
State	TN
ZIP	37916
Phone	865 637-7290
CertificateType	4
CertificateEffectiveDate	11/24/2022
CertificateExpirationDate	11/23/2024
FacilityType	Waiver

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