45D1079958 CLIA NUMBER - ATLANTIC MEDICAL PLLC

Laboratory Demographics

  • CLIA Code: 45D1079958
  • Facility Name: ATLANTIC MEDICAL PLLC
  • Facility Address: 8101 ROUGHRIDER DRIVE
    WINDCREST, TX
    ZIP 78239
  • Facility Phone: 210 657-3700
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EARL C. RUBY
  • NPI Number: 1992973200
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D1079958
LAB Type Physician Office
Facility Name ATLANTIC MEDICAL PLLC
Street 8101 ROUGHRIDER DRIVE
City WINDCREST
State TX
ZIP 78239
Phone 210 657-3700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/11/2024
Certificate Expiration Date 2/10/2026
Facility Type Physician Office
Lab Director EARL C. RUBY

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