45D0989254 CLIA NUMBER - BRIDGEPORT MEDICAL LODGE

Laboratory Demographics

  • CLIA Code: 45D0989254
  • Facility Name: BRIDGEPORT MEDICAL LODGE
  • Facility Address: 2108 15TH STREET
    BRIDGEPORT, TX
    ZIP 76426
  • Facility Phone: 940 683-5023
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: STEPHANIE SULOUFF
  • NPI Number: 1992013692
  • Taxonomy: 251300000X - Local Education Agency (LEA)

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CLIA Record

Field Name Field Value
CLIA Number 45D0989254
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name BRIDGEPORT MEDICAL LODGE
Street 2108 15TH STREET
City BRIDGEPORT
State TX
ZIP 76426
Phone 940 683-5023
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/20/2025
Certificate Expiration Date 7/19/2027
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director STEPHANIE SULOUFF

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