45D2196247 CLIA NUMBER - REVIVE MEDICAL, PLLC

Laboratory Demographics

  • CLIA Code: 45D2196247
  • Facility Name: REVIVE MEDICAL, PLLC
  • Facility Address: 12285 PELLICANO SUITE A2
    EL PASO, TX
    ZIP 79936
  • Facility Phone: 915 248-4863
  • Facility Type: Other - TEXAS LICENSED ALS FRO
  • Facility Type: Waiver
  • Lab Director: CLIFFORD O. JANKE
  • NPI Number: 1679239180
  • Taxonomy: 261QE0002X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D2196247
LAB Type Other - TEXAS LICENSED ALS FRO
Facility Name REVIVE MEDICAL, PLLC
Street 12285 PELLICANO SUITE A2
City EL PASO
State TX
ZIP 79936
Phone 915 248-4863
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/15/2024
Certificate Expiration Date 10/14/2026
Facility Type Other - TEXAS LICENSED ALS FRO
Lab Director CLIFFORD O. JANKE

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