45D0989249 CLIA NUMBER - WIMBERLEY PEDIATRIC & ADOLESCENT MEDICINE PA

Laboratory Demographics

  • CLIA Code: 45D0989249
  • Facility Name: WIMBERLEY PEDIATRIC & ADOLESCENT MEDICINE PA
  • Facility Address: 180 JOE WIMBERLEY BLVD SUITE 102
    WIMBERLEY, TX
    ZIP 78676
  • Facility Phone: 512 847-7700
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: ROGER D. PRUITT DO
  • NPI Number: 1437685880
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D0989249
LAB Type Physician Office
Facility Name WIMBERLEY PEDIATRIC & ADOLESCENT MEDICINE PA
Street 180 JOE WIMBERLEY BLVD SUITE 102
City WIMBERLEY
State TX
ZIP 78676
Phone 512 847-7700
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 6/10/2024
Certificate Expiration Date 6/9/2026
Facility Type Physician Office
Lab Director ROGER D. PRUITT DO

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This page was last updated on: 6/4/2025