45D1060503 CLIA NUMBER - ETMC PHYSICIAN GROUP, INC

Laboratory Demographics

  • CLIA Code: 45D1060503
  • Facility Name: ETMC PHYSICIAN GROUP, INC
  • Facility Address: 100 MUNICIPAL DR STE 300
    GUN BARREL CITY, TX
    ZIP 75156
  • Facility Phone: 903 713-1574
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: WILLIAM R. GILES
  • NPI Number: 1689241945
  • Taxonomy: 261QR1300X - Clinic/Center

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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
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 12/22/2023
Certificate Expiration Date 12/21/2025
Facility Type Physician Office
Lab Director WILLIAM R. GILES

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