45D1051637 CLIA NUMBER - GENESIS HEALTH & WELLNESS PA

Laboratory Demographics

CLIA Number: 45D1051637

Facility Name: GENESIS HEALTH & WELLNESS PA

Facility Address:
4855 RIVERSTONE BLVD STE 103
MISSOURI CITY, TX
ZIP 77459
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Facility Phone Number: 281 313-6348

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1790974541

Taxonomy: 207QA0505X - Family Medicine
The National Uniform Claim Committee (NUCC) recommends code 207QA0505X not be used. Choose a more appropriate code.

CLIA Record

Field Name	Field Value
CLIA Number	45D1051637
LAB Type	Physician Office
Facility Name	GENESIS HEALTH & WELLNESS PA
Street	4855 RIVERSTONE BLVD STE 103
City	MISSOURI CITY
State	TX
ZIP	77459
Phone	281 313-6348
CertificateType	4
CertificateEffectiveDate	3/7/2024
CertificateExpirationDate	3/6/2026
FacilityType	Waiver

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