MTN LAKE UROLOGY PC
NPI 1801050364
Specialist in Scottsboro, AL

Q: What is Mtn Lake Urology PC's NPI number?

The NPI number for Mtn Lake Urology PC is 1801050364. It was assigned to this organization in the NPPES registry on July 14, 2008.

Q: What is Mtn Lake Urology PC's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Active since July 14, 2008CLIA 01D2123209 · Microscopy

750 BYRON RD, SCOTTSBORO, AL 35769(256) 259-8765(256) 716-8060 Get Directions Write a Review

NPPES record last updated: March 21, 2018. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Mtn Lake Urology Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MTN LAKE UROLOGY PC (NPI 1801050364) is a healthcare organization registered as a specialist in Scottsboro, Alabama and active in the NPI registry since July 2008. The organization holds a CLIA Microscopy certificate valid through December 13, 2026 and lists Sherry Gross, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1801050364

Entity TypeOrganization

Primary Taxonomy174400000X

Legal Business NameMTN LAKE UROLOGY PC

Location Address750 BYRON RDScottsboro, AL 35769-4051

Mailing Address750 Byron RdScottsboro, AL 35769-4051 · (256) 259-8765 · Fax (256) 716-8060

Phone(256) 259-8765

Fax(256) 716-8060

Organization SubpartNo

Authorized OfficialSherry GrossOffice Manager · (256) 259-8765

Enumeration DateJuly 14, 2008

Last NPPES UpdateMarch 21, 2018

✔ NPI 1801050364 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers

Taxonomy Code174400000X

License✔ Licensed in AL · 17993

Definition

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.

750 BYRON RD, Scottsboro, AL 35769

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Other Identifiers 1

Medicaid106277AL

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Magnolia Health, Ambetter Health, Ambetter of Alabama and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 01D2123209

Mtn Lake Urology PC · Scottsboro, AL

Active · expires Dec 13, 2026

CLIA Number01D2123209

Laboratory TypePhysician Office

Certificate Effective DateDecember 14, 2024

Certificate Expiration DateDecember 13, 2026

Laboratory DirectorMichael G. Simmons MD

Laboratory Phone(256) 259-8765

Laboratory LocationMtn Lake Urology PC750 Byron Road, Scottsboro, AL 35769

CLIA data matches this NPI record on: Address Name Phone

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.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KERRY DALE WALKER CRNP

Nurse Practitioner (Family)

750 BYRON RD
SCOTTSBORO, AL 35769

Jackson County (256) 259-8765

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mtn Lake Urology PC's NPI number?

The NPI number for Mtn Lake Urology PC is 1801050364. It was assigned to this organization in the NPPES registry on July 14, 2008.

Where is Mtn Lake Urology PC located?

Mtn Lake Urology PC is located at 750 Byron Rd, Scottsboro, AL 35769. The listed phone number is (256) 259-8765.

What is Mtn Lake Urology PC's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Does Mtn Lake Urology PC hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 01D2123209) is associated with this NPI, valid through December 13, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Mtn Lake Urology PC accept?

Health plans from Ambetter Health, Ambetter from Magnolia Health, Ambetter of Alabama and Ambetter of Tennessee list Mtn Lake Urology PC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Mtn Lake Urology PC was last updated on March 21, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.