45D2196977 CLIA NUMBER - DIMMIT REGIONAL HOSPITAL DBA LUEVANO HEALTHCARE

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Laboratory Demographics

CLIA Number: 45D2196977

Facility Name: DIMMIT REGIONAL HOSPITAL DBA LUEVANO HEALTHCARE

Facility Address:
1313 VETERANS BOULEVARD
CRYSTAL CITY, TX
ZIP 78839
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Facility Phone Number: 830 255-2277

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1750901070

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D2196977
LAB Type	Rural Health Clinic
Facility Name	DIMMIT REGIONAL HOSPITAL DBA LUEVANO HEALTHCARE
Street	1313 VETERANS BOULEVARD
City	CRYSTAL CITY
State	TX
ZIP	78839
Phone	830 255-2277
CertificateType	4
CertificateEffectiveDate	10/21/2022
CertificateExpirationDate	10/20/2024
FacilityType	Waiver

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