45D1060503 CLIA NUMBER - ETMC PHYSICIAN GROUP, INC

Laboratory Demographics

CLIA Number: 45D1060503

Facility Name: ETMC PHYSICIAN GROUP, INC

Facility Address:
100 MUNICIPAL DR STE 300
GUN BARREL CITY, TX
ZIP 75156
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Facility Phone Number: 903 713-1574

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1689241945

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D1060503
LAB Type	Physician Office
Facility Name	ETMC PHYSICIAN GROUP, INC
Street	100 MUNICIPAL DR STE 300
City	GUN BARREL CITY
State	TX
ZIP	75156
Phone	903 713-1574
CertificateType	3
CertificateEffectiveDate	12/22/2023
CertificateExpirationDate	12/21/2025
FacilityType	PPMP

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