45D2092100 CLIA NUMBER - JOLLYVILLE PEDIATRICS

Laboratory Demographics

  • CLIA Code: 45D2092100
  • Facility Name: JOLLYVILLE PEDIATRICS
  • Facility Address: 11851 JOLLYVILLE RD SUITE 204
    AUSTIN, TX
    ZIP 78759
  • Facility Phone: 512 219-5550
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. EVELYN SPENCER
  • NPI Number: 1295868842
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 45D2092100
LAB Type Physician Office
Facility Name JOLLYVILLE PEDIATRICS
Street 11851 JOLLYVILLE RD SUITE 204
City AUSTIN
State TX
ZIP 78759
Phone 512 219-5550
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/26/2025
Certificate Expiration Date 2/25/2027
Facility Type Physician Office
Lab Director DR. EVELYN SPENCER

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