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45D1050239 CLIA NUMBER - SHANNON CLINIC BAPTIST MEMORIAL CAMPUS

Laboratory Demographics

CLIA Number: 45D1050239

Facility Name: SHANNON CLINIC BAPTIST MEMORIAL CAMPUS

Facility Address:
903 NORTH MAIN
SAN ANGELO, TX
ZIP 76903
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Facility Phone Number: 325 658-1511

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1114119385

Taxonomy: 291U00000X - Clinical Medical Laboratory
(1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology.

CLIA Record

Field Name Field Value
CLIA Number 45D1050239
LAB Type Physician Office
Facility Name SHANNON CLINIC BAPTIST MEMORIAL CAMPUS
Street 903 NORTH MAIN
City SAN ANGELO
State TX
ZIP 76903
Phone 325 658-1511
CertificateType 4
CertificateEffectiveDate 1/30/2024
CertificateExpirationDate 1/29/2026
FacilityType Waiver

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