45D2188789 CLIA NUMBER - WAVERLY PRIMARY CARE, PLLC

Laboratory Demographics

  • CLIA Code: 45D2188789
  • Facility Name: WAVERLY PRIMARY CARE, PLLC
  • Facility Address: 9329 STATE HWY 75 SOUTH
    NEW WAVERLY, TX
    ZIP 77358
  • Facility Phone: 936 284-2055
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KRISTINA K. MATA
  • NPI Number: 1215557715
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 45D2188789
LAB Type Physician Office
Facility Name WAVERLY PRIMARY CARE, PLLC
Street 9329 STATE HWY 75 SOUTH
City NEW WAVERLY
State TX
ZIP 77358
Phone 936 284-2055
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/22/2024
Certificate Expiration Date 7/21/2026
Facility Type Physician Office
Lab Director KRISTINA K. MATA

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