45D2205083 CLIA NUMBER - TEXAS INDUSTRIAL MEDICAL

Laboratory Demographics

  • CLIA Code: 45D2205083
  • Facility Name: TEXAS INDUSTRIAL MEDICAL
  • Facility Address: 1009 SOUTH BROADWAY ST
    LA PORTE, TX
    ZIP 77571
  • Facility Phone: 281 941-4174
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RICKY W. MOSES
  • NPI Number: 1063798866
  • Taxonomy: 363L00000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 45D2205083
LAB Type Physician Office
Facility Name TEXAS INDUSTRIAL MEDICAL
Street 1009 SOUTH BROADWAY ST
City LA PORTE
State TX
ZIP 77571
Phone 281 941-4174
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/11/2024
Certificate Expiration Date 12/10/2026
Facility Type Physician Office
Lab Director RICKY W. MOSES

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