45D2063739 CLIA NUMBER - PREMISE HEALTH OF TEXAS MEDICAL, PA

Laboratory Demographics

  • CLIA Code: 45D2063739
  • Facility Name: PREMISE HEALTH OF TEXAS MEDICAL, PA
  • Facility Address: 1301 LOOP 197 N
    TEXAS CITY, TX
    ZIP 77590
  • Facility Phone: 409 641-8134
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DEBRA KIMMEY
  • NPI Number: 1053138917
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D2063739
LAB Type Physician Office
Facility Name PREMISE HEALTH OF TEXAS MEDICAL, PA
Street 1301 LOOP 197 N
City TEXAS CITY
State TX
ZIP 77590
Phone 409 641-8134
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/7/2023
Certificate Expiration Date 8/6/2025
Facility Type Physician Office
Lab Director DEBRA KIMMEY

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This page was last updated on: 3/20/2025