45D0881498 CLIA NUMBER - CHARLES A LIVELY MD PA

Laboratory Demographics

  • CLIA Code: 45D0881498
  • Facility Name: CHARLES A LIVELY MD PA
  • Facility Address: 608 NORTH MUSKINGUM
    ODESSA, TX
    ZIP 79761
  • Facility Phone: 432 580-9168
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: CHARLES A. LIVELY
  • NPI Number: 1326062589
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 45D0881498
LAB Type Physician Office
Facility Name CHARLES A LIVELY MD PA
Street 608 NORTH MUSKINGUM
City ODESSA
State TX
ZIP 79761
Phone 432 580-9168
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 9/15/2024
Certificate Expiration Date 9/14/2026
Facility Type Physician Office
Lab Director CHARLES A. LIVELY

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