45D1023275 CLIA NUMBER - PEDIATRIC GASTROENTEROLOGY CONSULTANT

Laboratory Demographics

CLIA Number: 45D1023275

Facility Name: PEDIATRIC GASTROENTEROLOGY CONSULTANT

Facility Address:
740 HOSPITAL DR STE 120
BEAUMONT, TX
ZIP 77701
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Facility Phone Number: 409 813-3883

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1386687762

Taxonomy: 2080P0206X - Pediatrics
A pediatrician who specializes in the diagnosis and treatment of diseases of the digestive systems of infants, children and adolescents. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using lighted scopes to see internal organs.

CLIA Record

Field Name	Field Value
CLIA Number	45D1023275
LAB Type	Physician Office
Facility Name	PEDIATRIC GASTROENTEROLOGY CONSULTANT
Street	740 HOSPITAL DR STE 120
City	BEAUMONT
State	TX
ZIP	77701
Phone	409 813-3883
CertificateType	4
CertificateEffectiveDate	10/12/2022
CertificateExpirationDate	10/11/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024