45D0981427 CLIA NUMBER - SUSAN BOULLIOUN MD PA

Laboratory Demographics

  • CLIA Code: 45D0981427
  • Facility Name: SUSAN BOULLIOUN MD PA
  • Facility Address: 113 E CEDAR STREET
    SEGUIN, TX
    ZIP 78155
  • Facility Phone: 830 303-3500
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SUSAN L. BOULLIOUN
  • NPI Number: 1528148889
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D0981427
LAB Type Physician Office
Facility Name SUSAN BOULLIOUN MD PA
Street 113 E CEDAR STREET
City SEGUIN
State TX
ZIP 78155
Phone 830 303-3500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/27/2024
Certificate Expiration Date 12/26/2026
Facility Type Physician Office
Lab Director SUSAN L. BOULLIOUN

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This page was last updated on: 3/20/2025