45D2173254 CLIA NUMBER - MEMORIAL HERMANN MEDICAL GROUP SUGAR LAND PEDIATRICS

Laboratory Demographics

CLIA Number: 45D2173254

Facility Name: MEMORIAL HERMANN MEDICAL GROUP SUGAR LAND PEDIATRICS

Facility Address:
17510 WEST GRAND PARKWAY, SUITE 310
SUGAR LAND, TX
ZIP 77479
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Facility Phone Number: 713 338-7942

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1952331092

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D2173254
LAB Type	Physician Office
Facility Name	MEMORIAL HERMANN MEDICAL GROUP SUGAR LAND PEDIATRICS
Street	17510 WEST GRAND PARKWAY, SUITE 310
City	SUGAR LAND
State	TX
ZIP	77479
Phone	713 338-7942
CertificateType	4
CertificateEffectiveDate	10/8/2023
CertificateExpirationDate	10/7/2025
FacilityType	Waiver

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