45D2167362 CLIA NUMBER - IMPACT HEALTH DIRECT PRIMARY CARE, PLLC

Laboratory Demographics

CLIA Number: 45D2167362

Facility Name: IMPACT HEALTH DIRECT PRIMARY CARE, PLLC

Facility Address:
711 WEST LAMPASAS STREET ATTN KARA SJOGREN
ENNIS, TX
ZIP 75119
Get Directions

Facility Phone Number: 817 564-3575

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1760004188

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D2167362
LAB Type	Physician Office
Facility Name	IMPACT HEALTH DIRECT PRIMARY CARE, PLLC
Street	711 WEST LAMPASAS STREET ATTN KARA SJOGREN
City	ENNIS
State	TX
ZIP	75119
Phone	817 564-3575
CertificateType	3
CertificateEffectiveDate	6/6/2023
CertificateExpirationDate	6/5/2025
FacilityType	PPMP

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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