45D1105894 CLIA NUMBER - EAST TEXAS SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 45D1105894
  • Facility Name: EAST TEXAS SURGERY CENTER
  • Facility Address: 1402 MEDICAL DR ATTN VIVIAN EBRAHIM
    SULPHUR SPRINGS, TX
    ZIP 75482
  • Facility Phone: 903 558-3333
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: VIVIAN S. EBRAHIM
  • NPI Number: 1629356787
  • Taxonomy: 225100000X - Physical Therapist

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CLIA Record

Field Name Field Value
CLIA Number 45D1105894
LAB Type Ambulatory Surgery Center
Facility Name EAST TEXAS SURGERY CENTER
Street 1402 MEDICAL DR ATTN VIVIAN EBRAHIM
City SULPHUR SPRINGS
State TX
ZIP 75482
Phone 903 558-3333
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/10/2025
Certificate Expiration Date 5/9/2027
Facility Type Ambulatory Surgery Center
Lab Director VIVIAN S. EBRAHIM

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