45D1048310 CLIA NUMBER - CHARLES GREGORY FAMILY MEDICINE DO

Laboratory Demographics

  • CLIA Code: 45D1048310
  • Facility Name: CHARLES GREGORY FAMILY MEDICINE DO
  • Facility Address: 311 B BUDDY GANEM
    PORTLAND, TX
    ZIP 78374
  • Facility Phone: 361 643-9800
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHARLES C. GREGORY
  • NPI Number: 1477581221
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D1048310
LAB Type Physician Office
Facility Name CHARLES GREGORY FAMILY MEDICINE DO
Street 311 B BUDDY GANEM
City PORTLAND
State TX
ZIP 78374
Phone 361 643-9800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/29/2023
Certificate Expiration Date 11/28/2025
Facility Type Physician Office
Lab Director CHARLES C. GREGORY

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