45D0922994 CLIA NUMBER - ETMC PHYSICIAN GROUP, INC

Laboratory Demographics

  • CLIA Code: 45D0922994
  • Facility Name: ETMC PHYSICIAN GROUP, INC
  • Facility Address: 125 HIGHWAY 31 EAST
    CHANDLER, TX
    ZIP 75758
  • Facility Phone: 903 849-3862
  • Facility Type: Other
  • Facility Type: Microscopy
  • Lab Director: SAMUEL RABORN
  • NPI Number: 1235706581
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D0922994
LAB Type Other
Facility Name ETMC PHYSICIAN GROUP, INC
Street 125 HIGHWAY 31 EAST
City CHANDLER
State TX
ZIP 75758
Phone 903 849-3862
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 12/11/2024
Certificate Expiration Date 12/10/2026
Facility Type Other
Lab Director SAMUEL RABORN

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