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45D2062620 CLIA NUMBER - VMD PRIMARY PROVIDERS OF SOUTH CENTRAL TEXAS EVERGREEN FP

Laboratory Demographics

CLIA Number: 45D2062620

Facility Name: VMD PRIMARY PROVIDERS OF SOUTH CENTRAL TEXAS EVERGREEN FP

Facility Address:
11207 N LAMAR BLVD, SUITE B
AUSTIN, TX
ZIP 78753
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Facility Phone Number: 512 988-5355

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1730404138

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name Field Value
CLIA Number 45D2062620
LAB Type Physician Office
Facility Name VMD PRIMARY PROVIDERS OF SOUTH CENTRAL TEXAS EVERGREEN FP
Street 11207 N LAMAR BLVD, SUITE B
City AUSTIN
State TX
ZIP 78753
Phone 512 988-5355
CertificateType 4
CertificateEffectiveDate 7/19/2023
CertificateExpirationDate 7/18/2025
FacilityType Waiver

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