45D0877279 CLIA NUMBER - PERMIAN GASTROENTEROLOGY ASSOCIATES

Laboratory Demographics

CLIA Number: 45D0877279

Facility Name: PERMIAN GASTROENTEROLOGY ASSOCIATES

Facility Address:
315 EAST 5TH STREET
ODESSA, TX
ZIP 79761
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Facility Phone Number: 432 333-3433

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1295946259

Taxonomy: 207RG0100X - Internal Medicine
An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs.

CLIA Record

Field Name	Field Value
CLIA Number	45D0877279
LAB Type	Physician Office
Facility Name	PERMIAN GASTROENTEROLOGY ASSOCIATES
Street	315 EAST 5TH STREET
City	ODESSA
State	TX
ZIP	79761
Phone	432 333-3433
CertificateType	4
CertificateEffectiveDate	9/30/2023
CertificateExpirationDate	9/29/2025
FacilityType	Waiver

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