45D2220951 CLIA NUMBER - BRIDGE FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 45D2220951
  • Facility Name: BRIDGE FAMILY PRACTICE
  • Facility Address: 443 HOUSTON
    PORTLAND, TX
    ZIP 78374
  • Facility Phone: 361 997-2059
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARTHA A. MOON
  • NPI Number: 1548849813
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D2220951
LAB Type Physician Office
Facility Name BRIDGE FAMILY PRACTICE
Street 443 HOUSTON
City PORTLAND
State TX
ZIP 78374
Phone 361 997-2059
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/16/2025
Certificate Expiration Date 4/15/2027
Facility Type Physician Office
Lab Director MARTHA A. MOON

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