45D0987623 CLIA NUMBER - AUSTIN CHILDREN'S CLINIC PA

Laboratory Demographics

  • CLIA Code: 45D0987623
  • Facility Name: AUSTIN CHILDREN'S CLINIC PA
  • Facility Address: 11673 JOLLEYVILLE ROAD, SUITE 104
    AUSTIN, TX
    ZIP 78759
  • Facility Phone: 512 338-5130
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARY C. PETROPOULOS MD
  • NPI Number: 1508080516
  • Taxonomy: 2080A0000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 45D0987623
LAB Type Physician Office
Facility Name AUSTIN CHILDREN'S CLINIC PA
Street 11673 JOLLEYVILLE ROAD, SUITE 104
City AUSTIN
State TX
ZIP 78759
Phone 512 338-5130
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/27/2024
Certificate Expiration Date 4/26/2026
Facility Type Physician Office
Lab Director MARY C. PETROPOULOS MD

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