45D0989946 CLIA NUMBER - MEDICAL CENTER PAVILLION

Laboratory Demographics

  • CLIA Code: 45D0989946
  • Facility Name: MEDICAL CENTER PAVILLION
  • Facility Address: 4647 MEDICAL DRIVE
    SAN ANTONIO, TX
    ZIP 78229
  • Facility Phone: 210 358-8144
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RUSSELL HIGGINS
  • NPI Number: 1861602583
  • Taxonomy: 207W00000X - Ophthalmology

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CLIA Record

Field Name Field Value
CLIA Number 45D0989946
LAB Type Physician Office
Facility Name MEDICAL CENTER PAVILLION
Street 4647 MEDICAL DRIVE
City SAN ANTONIO
State TX
ZIP 78229
Phone 210 358-8144
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/12/2024
Certificate Expiration Date 1/11/2026
Facility Type Physician Office
Lab Director RUSSELL HIGGINS

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