45D2136592 CLIA NUMBER - DIRECT MED CLINIC

Laboratory Demographics

  • CLIA Code: 45D2136592
  • Facility Name: DIRECT MED CLINIC
  • Facility Address: 1010 NW LOOP 410, SUITE 100A
    SAN ANTONIO, TX
    ZIP 78213
  • Facility Phone: 210 886-8031
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ROGER M. MOCZYGEMBA
  • NPI Number: 1689104846
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D2136592
LAB Type Physician Office
Facility Name DIRECT MED CLINIC
Street 1010 NW LOOP 410, SUITE 100A
City SAN ANTONIO
State TX
ZIP 78213
Phone 210 886-8031
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/12/2025
Certificate Expiration Date 9/11/2027
Facility Type Physician Office
Lab Director ROGER M. MOCZYGEMBA

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