45D2131531 CLIA NUMBER - PRIME MEDIC PA

Laboratory Demographics

CLIA Number: 45D2131531

Facility Name: PRIME MEDIC PA

Facility Address:
19701 KINGWOOD DR BLDG 10
KINGWOOD, TX
ZIP 77339
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Facility Phone Number: 281 713-9394

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1487192316

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D2131531
LAB Type	Physician Office
Facility Name	PRIME MEDIC PA
Street	19701 KINGWOOD DR BLDG 10
City	KINGWOOD
State	TX
ZIP	77339
Phone	281 713-9394
CertificateType	4
CertificateEffectiveDate	5/31/2023
CertificateExpirationDate	5/30/2025
FacilityType	Waiver

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