45D2181370 CLIA NUMBER - METHADONE CLINIC OF EAST TEXAS LLC TYLER

Laboratory Demographics

CLIA Number: 45D2181370

Facility Name: METHADONE CLINIC OF EAST TEXAS LLC TYLER

Facility Address:
1510 S VINE AVE
TYLER, TX
ZIP 75701
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Facility Phone Number: 903 526-4055

Facility Type: Other - OPIOD TREATMENT CTR

Certificate Type: Waiver

NPI Number: 1104144088

Taxonomy: 261QM2800X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction.

CLIA Record

Field Name	Field Value
CLIA Number	45D2181370
LAB Type	Other - OPIOD TREATMENT CTR
Facility Name	METHADONE CLINIC OF EAST TEXAS LLC TYLER
Street	1510 S VINE AVE
City	TYLER
State	TX
ZIP	75701
Phone	903 526-4055
CertificateType	4
CertificateEffectiveDate	4/2/2024
CertificateExpirationDate	4/1/2026
FacilityType	Waiver

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