45D2079019 CLIA NUMBER - HOUSTON METHODIST PRIMARY CARE GROUP

Laboratory Demographics

  • CLIA Code: 45D2079019
  • Facility Name: HOUSTON METHODIST PRIMARY CARE GROUP
  • Facility Address: 6560 FANNIN SUITE 1130
    HOUSTON, TX
    ZIP 77030
  • Facility Phone: 713 363-8055
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KETTI AWAD
  • NPI Number: 1245862531
  • Taxonomy: 207QA0401X - Family Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 45D2079019
LAB Type Physician Office
Facility Name HOUSTON METHODIST PRIMARY CARE GROUP
Street 6560 FANNIN SUITE 1130
City HOUSTON
State TX
ZIP 77030
Phone 713 363-8055
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/9/2024
Certificate Expiration Date 6/8/2026
Facility Type Physician Office
Lab Director KETTI AWAD

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

This page was last updated on: 6/4/2025