45D2106771 CLIA NUMBER - GRACE CLINIC OF LUBBOCK

Laboratory Demographics

CLIA Number: 45D2106771

Facility Name: GRACE CLINIC OF LUBBOCK

Facility Address:
2424 50TH SUITE 202
LUBBOCK, TX
ZIP 79412
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Facility Phone Number: 806 744-7223

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1558523357

Taxonomy: 2085R0202X - Radiology
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

CLIA Record

Field Name	Field Value
CLIA Number	45D2106771
LAB Type	Physician Office
Facility Name	GRACE CLINIC OF LUBBOCK
Street	2424 50TH SUITE 202
City	LUBBOCK
State	TX
ZIP	79412
Phone	806 744-7223
CertificateType	4
CertificateEffectiveDate	12/29/2023
CertificateExpirationDate	12/28/2025
FacilityType	Waiver

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