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45D2160873 CLIA NUMBER - PROVIDENCE MEDICAL PARTNERS

Laboratory Demographics

CLIA Number: 45D2160873

Facility Name: PROVIDENCE MEDICAL PARTNERS

Facility Address:
9870 GATEWAY N BLVD SUITE A
EL PASO, TX
ZIP 79924
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Facility Phone Number: 915 271-4635

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1689031387

Taxonomy: 208000000X - Pediatrics
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

CLIA Record

Field Name Field Value
CLIA Number 45D2160873
LAB Type Physician Office
Facility Name PROVIDENCE MEDICAL PARTNERS
Street 9870 GATEWAY N BLVD SUITE A
City EL PASO
State TX
ZIP 79924
Phone 915 271-4635
CertificateType 4
CertificateEffectiveDate 1/22/2023
CertificateExpirationDate 1/21/2025
FacilityType Waiver

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