45D2180634 CLIA NUMBER - MODERN PEDIATRICS PROFESSIONALS, PLLC

Laboratory Demographics

  • CLIA Code: 45D2180634
  • Facility Name: MODERN PEDIATRICS PROFESSIONALS, PLLC
  • Facility Address: 2106 RABB GLEN STREET
    AUSTIN, TX
    ZIP 78704
  • Facility Phone: 319 541-7604
  • Facility Type: Other - HOUSE-CALLS ONLY
  • Facility Type: Waiver
  • Lab Director: TIMOTHY J. PORTER
  • NPI Number: 1154952505
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 45D2180634
LAB Type Other - HOUSE-CALLS ONLY
Facility Name MODERN PEDIATRICS PROFESSIONALS, PLLC
Street 2106 RABB GLEN STREET
City AUSTIN
State TX
ZIP 78704
Phone 319 541-7604
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/18/2024
Certificate Expiration Date 3/17/2026
Facility Type Other - HOUSE-CALLS ONLY
Lab Director TIMOTHY J. PORTER

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