45D2173530 CLIA NUMBER - BOTTENFIELD PEDIATRIC ASSOCIATES

Laboratory Demographics

  • CLIA Code: 45D2173530
  • Facility Name: BOTTENFIELD PEDIATRIC ASSOCIATES
  • Facility Address: 207 THAT WAY A-1
    LAKE JACKSON, TX
    ZIP 77566
  • Facility Phone: 979 297-7337
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GERALD BOTTENFIELD
  • NPI Number: 1710540513
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 45D2173530
LAB Type Physician Office
Facility Name BOTTENFIELD PEDIATRIC ASSOCIATES
Street 207 THAT WAY A-1
City LAKE JACKSON
State TX
ZIP 77566
Phone 979 297-7337
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/15/2025
Certificate Expiration Date 10/14/2027
Facility Type Physician Office
Lab Director GERALD BOTTENFIELD

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