45D0696469 CLIA NUMBER - WOODSBORO MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 45D0696469
  • Facility Name: WOODSBORO MEDICAL CLINIC
  • Facility Address: 120 WOOD AVENUE
    WOODSBORO, TX
    ZIP 78393
  • Facility Phone: 361 543-5414
  • Facility Type: Community Clinic
  • Facility Type: Microscopy
  • Lab Director: RUSSELL MASCARENHAS
  • NPI Number: 1114049855
  • Taxonomy: 251300000X - Local Education Agency (LEA)

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CLIA Record

Field Name Field Value
CLIA Number 45D0696469
LAB Type Community Clinic
Facility Name WOODSBORO MEDICAL CLINIC
Street 120 WOOD AVENUE
City WOODSBORO
State TX
ZIP 78393
Phone 361 543-5414
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 3/30/2024
Certificate Expiration Date 3/29/2026
Facility Type Community Clinic
Lab Director RUSSELL MASCARENHAS

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