45D2079649 CLIA NUMBER - WHITNEY FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 45D2079649
  • Facility Name: WHITNEY FAMILY MEDICINE
  • Facility Address: 1314 N BRAZOS STREET
    WHITNEY, TX
    ZIP 76692
  • Facility Phone: 254 694-3621
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: RANDALL D. HENDERSON
  • NPI Number: 1508063504
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 45D2079649
LAB Type Physician Office
Facility Name WHITNEY FAMILY MEDICINE
Street 1314 N BRAZOS STREET
City WHITNEY
State TX
ZIP 76692
Phone 254 694-3621
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 6/19/2024
Certificate Expiration Date 6/18/2026
Facility Type Physician Office
Lab Director RANDALL D. HENDERSON

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