45D2135467 CLIA NUMBER - HEAD PEDIATRICS, PLLC

Laboratory Demographics

  • CLIA Code: 45D2135467
  • Facility Name: HEAD PEDIATRICS, PLLC
  • Facility Address: 625 RUSSELL BLVD
    NACOGDOCHES, TX
    ZIP 75965
  • Facility Phone: 936 305-5050
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RYAN E. HEAD
  • NPI Number: 1255725982
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 45D2135467
LAB Type Physician Office
Facility Name HEAD PEDIATRICS, PLLC
Street 625 RUSSELL BLVD
City NACOGDOCHES
State TX
ZIP 75965
Phone 936 305-5050
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/22/2025
Certificate Expiration Date 8/21/2027
Facility Type Physician Office
Lab Director RYAN E. HEAD

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