45D1028036 CLIA NUMBER - LUBBOCK SPORTS MEDICINE ASSOCIATES

Laboratory Demographics

CLIA Number: 45D1028036

Facility Name: LUBBOCK SPORTS MEDICINE ASSOCIATES

Facility Address:
4110 22ND PLACE
LUBBOCK, TX
ZIP 79410
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Facility Phone Number: 806 792-4329

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1902842404

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	45D1028036
LAB Type	Physician Office
Facility Name	LUBBOCK SPORTS MEDICINE ASSOCIATES
Street	4110 22ND PLACE
City	LUBBOCK
State	TX
ZIP	79410
Phone	806 792-4329
CertificateType	4
CertificateEffectiveDate	7/20/2022
CertificateExpirationDate	7/19/2024
FacilityType	Waiver

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