45D2020395 CLIA NUMBER - UTMB STAFFORD WIC

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Laboratory Demographics

CLIA Number: 45D2020395

Facility Name: UTMB STAFFORD WIC

Facility Address:
2503 SOUTH MAIN, SUITE F
STAFFORD, TX
ZIP 77477
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Facility Phone Number: 936 327-5003

Facility Type: Other - HOSPITAL-BASED CLINIC WIC

Certificate Type: Waiver

NPI Number: 1063821981

Taxonomy: 261QP2400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D2020395
LAB Type	Other - HOSPITAL-BASED CLINIC WIC
Facility Name	UTMB STAFFORD WIC
Street	2503 SOUTH MAIN, SUITE F
City	STAFFORD
State	TX
ZIP	77477
Phone	936 327-5003
CertificateType	4
CertificateEffectiveDate	2/17/2023
CertificateExpirationDate	2/16/2025
FacilityType	Waiver

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