45D2192244 CLIA NUMBER - MEDI-EAGLE EXPRESS HEALTHCAR LLC

Laboratory Demographics

  • CLIA Code: 45D2192244
  • Facility Name: MEDI-EAGLE EXPRESS HEALTHCAR LLC
  • Facility Address: 4202 BERRY COVE CIRCLE
    RICHMOND, TX
    ZIP 77406
  • Facility Phone: 407 927-2891
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICAELA N. GORDON
  • NPI Number: 1275158420
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 45D2192244
LAB Type Physician Office
Facility Name MEDI-EAGLE EXPRESS HEALTHCAR LLC
Street 4202 BERRY COVE CIRCLE
City RICHMOND
State TX
ZIP 77406
Phone 407 927-2891
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/8/2024
Certificate Expiration Date 9/7/2026
Facility Type Physician Office
Lab Director MICAELA N. GORDON

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