45D2210736 CLIA NUMBER - TOTAL CARE OF MONTGOMERY, PLLC DBA REDEFINE

Laboratory Demographics

CLIA Number: 45D2210736

Facility Name: TOTAL CARE OF MONTGOMERY, PLLC DBA REDEFINE

Facility Address:
18441 TX 105 SUITE B
MONTGOMERY, TX
ZIP 77356
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Facility Phone Number: 936 494-9520

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1881369585

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	45D2210736
LAB Type	Practitioner Other
Facility Name	TOTAL CARE OF MONTGOMERY, PLLC DBA REDEFINE
Street	18441 TX 105 SUITE B
City	MONTGOMERY
State	TX
ZIP	77356
Phone	936 494-9520
CertificateType	4
CertificateEffectiveDate	1/22/2023
CertificateExpirationDate	1/21/2025
FacilityType	Waiver

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