50D2005947 CLIA NUMBER - MOUNT RAINIER UROLOGY

Laboratory Demographics

  • CLIA Code: 50D2005947
  • Facility Name: MOUNT RAINIER UROLOGY
  • Facility Address: 703 LILLY RD NE STE 106
    OLYMPIA, WA
    ZIP 98506
  • Facility Phone: 360 350-0281
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: SIMON P. ZADINA
  • NPI Number: 1053641183
  • Taxonomy: 208800000X - Urology

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CLIA Record

Field Name Field Value
CLIA Number 50D2005947
LAB Type Physician Office
Facility Name MOUNT RAINIER UROLOGY
Street 703 LILLY RD NE STE 106
City OLYMPIA
State WA
ZIP 98506
Phone 360 350-0281
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 4/8/2010
Certificate Expiration Date 4/4/2028
Facility Type Physician Office
Lab Director SIMON P. ZADINA

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