45D2067333 CLIA NUMBER - PROMONTORY GERIATRICS

Laboratory Demographics

  • CLIA Code: 45D2067333
  • Facility Name: PROMONTORY GERIATRICS
  • Facility Address: 2727 BOLTON BOONE DR, STE 114
    DESOTO, TX
    ZIP 75115
  • Facility Phone: 469 857-3142
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GENE O. BIGHAM
  • NPI Number: 1194044792
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D2067333
LAB Type Physician Office
Facility Name PROMONTORY GERIATRICS
Street 2727 BOLTON BOONE DR, STE 114
City DESOTO
State TX
ZIP 75115
Phone 469 857-3142
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/14/2025
Certificate Expiration Date 10/13/2027
Facility Type Physician Office
Lab Director GENE O. BIGHAM

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