45D0957442 CLIA NUMBER - MADHAVA AGUSALA, MD, PA

Laboratory Demographics

CLIA Number: 45D0957442

Facility Name: MADHAVA AGUSALA, MD, PA

Facility Address:
318 NORTH ALLEGHANEY, SUITE 201
ODESSA, TX
ZIP 79761
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Facility Phone Number: 432 337-2714

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1700915303

Taxonomy: 207RC0000X - Internal Medicine
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.

CLIA Record

Field Name	Field Value
CLIA Number	45D0957442
LAB Type	Physician Office
Facility Name	MADHAVA AGUSALA, MD, PA
Street	318 NORTH ALLEGHANEY, SUITE 201
City	ODESSA
State	TX
ZIP	79761
Phone	432 337-2714
CertificateType	4
CertificateEffectiveDate	2/21/2023
CertificateExpirationDate	2/20/2025
FacilityType	Waiver

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