45D2163329 CLIA NUMBER - MATAGORDA FAMILY PRACTICE

Laboratory Demographics

CLIA Number: 45D2163329

Facility Name: MATAGORDA FAMILY PRACTICE

Facility Address:
320 MAIN ST
PALACIOS, TX
ZIP 77465
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Facility Phone Number: 361 972-0095

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1467009092

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D2163329
LAB Type	Physician Office
Facility Name	MATAGORDA FAMILY PRACTICE
Street	320 MAIN ST
City	PALACIOS
State	TX
ZIP	77465
Phone	361 972-0095
CertificateType	4
CertificateEffectiveDate	3/12/2023
CertificateExpirationDate	3/11/2025
FacilityType	Waiver

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