45D1069077 CLIA NUMBER - MARK EDEN MD PA

Laboratory Demographics

  • CLIA Code: 45D1069077
  • Facility Name: MARK EDEN MD PA
  • Facility Address: 820 RUBEN STREET, SUITE B
    FREDERICKSBURG, TX
    ZIP 78624
  • Facility Phone: 830 997-9497
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: MARK D. EDEN
  • NPI Number: 1275528119
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D1069077
LAB Type Physician Office
Facility Name MARK EDEN MD PA
Street 820 RUBEN STREET, SUITE B
City FREDERICKSBURG
State TX
ZIP 78624
Phone 830 997-9497
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 5/29/2025
Certificate Expiration Date 5/28/2027
Facility Type Physician Office
Lab Director MARK D. EDEN

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