45D2226900 CLIA NUMBER - ST EDWARD'S UNIVERSITY HEALTH AND COUNCILING CENTER WITH AMG

Laboratory Demographics

CLIA Number: 45D2226900

Facility Name: ST EDWARD'S UNIVERSITY HEALTH AND COUNCILING CENTER WITH AMG

Facility Address:
3001 SOUTH CONGRESS, LADY BIRD JOHNSON HALL # 100 (B-LAB)
AUSTIN, TX
ZIP 78704
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Facility Phone Number: 512 324-4940

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1174991251

Taxonomy: 261QH0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D2226900
LAB Type	Physician Office
Facility Name	ST EDWARD'S UNIVERSITY HEALTH AND COUNCILING CENTER WITH AMG
Street	3001 SOUTH CONGRESS, LADY BIRD JOHNSON HALL # 100 (B-LAB)
City	AUSTIN
State	TX
ZIP	78704
Phone	512 324-4940
CertificateType	4
CertificateEffectiveDate	6/4/2023
CertificateExpirationDate	6/3/2025
FacilityType	Waiver

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