45D2233104 CLIA NUMBER - BOAZ COMPLETE FAMILY CARE

Laboratory Demographics

CLIA Number: 45D2233104

Facility Name: BOAZ COMPLETE FAMILY CARE

Facility Address:
200 W J BOAZ RD STE 200
SAGINAW, TX
ZIP 76179
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Facility Phone Number: 682 282-5440

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1629676754

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	45D2233104
LAB Type	Physician Office
Facility Name	BOAZ COMPLETE FAMILY CARE
Street	200 W J BOAZ RD STE 200
City	SAGINAW
State	TX
ZIP	76179
Phone	682 282-5440
CertificateType	4
CertificateEffectiveDate	8/19/2023
CertificateExpirationDate	8/18/2025
FacilityType	Waiver

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