45D1079275 CLIA NUMBER - WEST TEXAS WELLNESS CLINIC

Laboratory Demographics

CLIA Number: 45D1079275

Facility Name: WEST TEXAS WELLNESS CLINIC

Facility Address:
2453 E 11TH STREET
ODESSA, TX
ZIP 79761
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Facility Phone Number: 432 582-0300

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1891900080

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	45D1079275
LAB Type	Physician Office
Facility Name	WEST TEXAS WELLNESS CLINIC
Street	2453 E 11TH STREET
City	ODESSA
State	TX
ZIP	79761
Phone	432 582-0300
CertificateType	4
CertificateEffectiveDate	1/29/2024
CertificateExpirationDate	1/28/2026
FacilityType	Waiver

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