45D0988342 CLIA NUMBER - CONVIVA MEDICAL CENTER MANAGEMENT OF TEXAS PA DBA CONVIVA CARE CENTER

Laboratory Demographics

  • CLIA Code: 45D0988342
  • Facility Name: CONVIVA MEDICAL CENTER MANAGEMENT OF TEXAS PA DBA CONVIVA CARE CENTER
  • Facility Address: 107 CEDAR DRIVE
    PORTLAND, TX
    ZIP 78374
  • Facility Phone: 361 643-6623
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JEROME A. LEE SANG
  • NPI Number: 1164449948
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D0988342
LAB Type Physician Office
Facility Name CONVIVA MEDICAL CENTER MANAGEMENT OF TEXAS PA DBA CONVIVA CARE CENTER
Street 107 CEDAR DRIVE
City PORTLAND
State TX
ZIP 78374
Phone 361 643-6623
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/9/2025
Certificate Expiration Date 9/8/2027
Facility Type Physician Office
Lab Director JEROME A. LEE SANG

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