45D1057728 CLIA NUMBER - DOMINION MEDICAL ASSOCIATES

Laboratory Demographics

CLIA Number: 45D1057728

Facility Name: DOMINION MEDICAL ASSOCIATES

Facility Address:
11673 JOLLYVILLE RD STE 205
AUSTIN, TX
ZIP 78759
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Facility Phone Number: 512 834-9999

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1841201597

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	45D1057728
LAB Type	Physician Office
Facility Name	DOMINION MEDICAL ASSOCIATES
Street	11673 JOLLYVILLE RD STE 205
City	AUSTIN
State	TX
ZIP	78759
Phone	512 834-9999
CertificateType	4
CertificateEffectiveDate	1/1/2023
CertificateExpirationDate	12/31/2024
FacilityType	Waiver

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