45D2179586 CLIA NUMBER - JG NUTREND PROVIDERS, PA

Laboratory Demographics

  • CLIA Code: 45D2179586
  • Facility Name: JG NUTREND PROVIDERS, PA
  • Facility Address: 425 HOLDERRIETH BLVD, STE 212
    TOMBALL, TX
    ZIP 77375
  • Facility Phone: 346 246-3424
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOHN F. GILMORE
  • NPI Number: 1578185500
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D2179586
LAB Type Physician Office
Facility Name JG NUTREND PROVIDERS, PA
Street 425 HOLDERRIETH BLVD, STE 212
City TOMBALL
State TX
ZIP 77375
Phone 346 246-3424
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/26/2024
Certificate Expiration Date 2/25/2026
Facility Type Physician Office
Lab Director JOHN F. GILMORE

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