45D1018247 CLIA NUMBER - ETMC PHYSICIAN GROUP, INC

Laboratory Demographics

  • CLIA Code: 45D1018247
  • Facility Name: ETMC PHYSICIAN GROUP, INC
  • Facility Address: 1000 E 5TH STREET, SUITE 200
    TYLER, TX
    ZIP 75701
  • Facility Phone: (903) 590-5560
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: STEPHEN RYDZAK
  • NPI Number: 1609382662
  • Taxonomy: 207RC0000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D1018247
LAB Type Physician Office
Facility Name ETMC PHYSICIAN GROUP, INC
Street 1000 E 5TH STREET, SUITE 200
City TYLER
State TX
ZIP 75701
Phone 9035905560
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/15/2024
Certificate Expiration Date 8/14/2026
Facility Type Physician Office
Lab Director STEPHEN RYDZAK

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This page was last updated on: 5/18/2026