45D0953648 CLIA NUMBER - MARISE KELLY MD PA DBA BROADWAY CLINIC

Laboratory Demographics

  • CLIA Code: 45D0953648
  • Facility Name: MARISE KELLY MD PA DBA BROADWAY CLINIC
  • Facility Address: 900 BROADWAY
    HOUSTON, TX
    ZIP 77012
  • Facility Phone: 713 928-2774
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: MARISE KELLY
  • NPI Number: 1124056304
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D0953648
LAB Type Community Clinic
Facility Name MARISE KELLY MD PA DBA BROADWAY CLINIC
Street 900 BROADWAY
City HOUSTON
State TX
ZIP 77012
Phone 713 928-2774
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/28/2025
Certificate Expiration Date 4/27/2027
Facility Type Community Clinic
Lab Director MARISE KELLY

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