45D2099521 CLIA NUMBER - MEMORIAL MEDICAL CLINIC LABORATORY

Laboratory Demographics

  • CLIA Code: 45D2099521
  • Facility Name: MEMORIAL MEDICAL CLINIC LABORATORY
  • Facility Address: 1016 N VIRGINIA STREET
    PORT LAVACA, TX
    ZIP 77979
  • Facility Phone: 361 552-0284
  • Facility Type: Rural Health Clinic
  • Facility Type: Certificate of Compliance
  • Lab Director: BRYAN JANSSEN
  • NPI Number: 1689630865
  • Taxonomy: 282NC0060X - General Acute Care Hospital

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CLIA Record

Field Name Field Value
CLIA Number 45D2099521
LAB Type Rural Health Clinic
Facility Name MEMORIAL MEDICAL CLINIC LABORATORY
Street 1016 N VIRGINIA STREET
City PORT LAVACA
State TX
ZIP 77979
Phone 361 552-0284
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 8/11/2024
Certificate Expiration Date 8/10/2026
Facility Type Rural Health Clinic
Lab Director BRYAN JANSSEN

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