45D2099522 CLIA NUMBER - BRAZOS PRIMARY CARE ASSOCIATES

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Laboratory Demographics

CLIA Number: 45D2099522

Facility Name: BRAZOS PRIMARY CARE ASSOCIATES

Facility Address:
188 ABNER JACKSON PARKWAY
LAKE JACKSON, TX
ZIP 77566
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Facility Phone Number: 214 886-3901

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1366812760

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D2099522
LAB Type	Physician Office
Facility Name	BRAZOS PRIMARY CARE ASSOCIATES
Street	188 ABNER JACKSON PARKWAY
City	LAKE JACKSON
State	TX
ZIP	77566
Phone	214 886-3901
CertificateType	4
CertificateEffectiveDate	7/28/2023
CertificateExpirationDate	7/27/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024