45D1101077 CLIA NUMBER - VCPHCS VII LLC DBA MEDMARK TREATMENT CENTERS-SAN ANTONIO QUINCY

Laboratory Demographics

  • CLIA Code: 45D1101077
  • Facility Name: VCPHCS VII LLC DBA MEDMARK TREATMENT CENTERS-SAN ANTONIO QUINCY
  • Facility Address: 5121 CRESTWAY RD, SUITE 201
    WINDCREST, TX
    ZIP 78239
  • Facility Phone: 210 794-8684
  • Facility Type: Other
  • Facility Type: Waiver
  • Lab Director: JOHN PAUL BLAKELY
  • NPI Number: 1992966584
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D1101077
LAB Type Other
Facility Name VCPHCS VII LLC DBA MEDMARK TREATMENT CENTERS-SAN ANTONIO QUINCY
Street 5121 CRESTWAY RD, SUITE 201
City WINDCREST
State TX
ZIP 78239
Phone 210 794-8684
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/19/2025
Certificate Expiration Date 6/18/2027
Facility Type Other
Lab Director JOHN PAUL BLAKELY

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