45D2110567 CLIA NUMBER - PREMISE HEALTH OF TEXAS MEDICAL, PA

Laboratory Demographics

CLIA Number: 45D2110567

Facility Name: PREMISE HEALTH OF TEXAS MEDICAL, PA

Facility Address:
13138 LOCKWOOD ROAD
HOUSTON, TX
ZIP 77044
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Facility Phone Number: 281 569-6331

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1477911022

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	45D2110567
LAB Type	Physician Office
Facility Name	PREMISE HEALTH OF TEXAS MEDICAL, PA
Street	13138 LOCKWOOD ROAD
City	HOUSTON
State	TX
ZIP	77044
Phone	281 569-6331
CertificateType	4
CertificateEffectiveDate	3/16/2024
CertificateExpirationDate	3/15/2026
FacilityType	Waiver

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