45D0671939 CLIA NUMBER - KELLUM MEDICAL GROUP, PA

Laboratory Demographics

  • CLIA Code: 45D0671939
  • Facility Name: KELLUM MEDICAL GROUP, PA
  • Facility Address: 7323 MARBACH RD #104
    SAN ANTONIO, TX
    ZIP 78227
  • Facility Phone: 210 674-0257
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DANIEL KELLUM SR
  • NPI Number: 1508813494
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D0671939
LAB Type Physician Office
Facility Name KELLUM MEDICAL GROUP, PA
Street 7323 MARBACH RD #104
City SAN ANTONIO
State TX
ZIP 78227
Phone 210 674-0257
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/3/2024
Certificate Expiration Date 10/2/2026
Facility Type Physician Office
Lab Director DANIEL KELLUM SR

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