45D0931523 CLIA NUMBER - ELLIS PEDIATRICS PA

Laboratory Demographics

  • CLIA Code: 45D0931523
  • Facility Name: ELLIS PEDIATRICS PA
  • Facility Address: 12201 RENFERT WAY SUITE 110
    AUSTIN, TX
    ZIP 78758
  • Facility Phone: 512 491-5125
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LEIGHTON E. ELLIS
  • NPI Number: 1790932259
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 45D0931523
LAB Type Physician Office
Facility Name ELLIS PEDIATRICS PA
Street 12201 RENFERT WAY SUITE 110
City AUSTIN
State TX
ZIP 78758
Phone 512 491-5125
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/30/2025
Certificate Expiration Date 7/29/2027
Facility Type Physician Office
Lab Director LEIGHTON E. ELLIS

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