45D2208379 CLIA NUMBER - PERMIAN BASIN DRUG AND ALCOHOL

Laboratory Demographics

  • CLIA Code: 45D2208379
  • Facility Name: PERMIAN BASIN DRUG AND ALCOHOL
  • Facility Address: 1560 W 1-20 N SERVICES RD
    ODESSA, TX
    ZIP 79763
  • Facility Phone: 432 332-5700
  • Facility Type: Mobile Laboratory
  • Facility Type: Waiver
  • Lab Director: ATHENA MOON
  • NPI Number: 1821648502
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 45D2208379
LAB Type Mobile Laboratory
Facility Name PERMIAN BASIN DRUG AND ALCOHOL
Street 1560 W 1-20 N SERVICES RD
City ODESSA
State TX
ZIP 79763
Phone 432 332-5700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/6/2025
Certificate Expiration Date 1/5/2027
Facility Type Mobile Laboratory
Lab Director ATHENA MOON

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This page was last updated on: 3/20/2025