45D2238231 CLIA NUMBER - PRIME TELECARE LLC, OBA -PRIME FAMILY CARE

Laboratory Demographics

  • CLIA Code: 45D2238231
  • Facility Name: PRIME TELECARE LLC, OBA -PRIME FAMILY CARE
  • Facility Address: 1000 GATTIS SCHOOL ROAD SUITE 440
    ROUND ROCK, TX
    ZIP 78664
  • Facility Phone: 512 740-8993
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LITTY R. VADAKKAN
  • NPI Number: 1629678347
  • Taxonomy: 363L00000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 45D2238231
LAB Type Physician Office
Facility Name PRIME TELECARE LLC, OBA -PRIME FAMILY CARE
Street 1000 GATTIS SCHOOL ROAD SUITE 440
City ROUND ROCK
State TX
ZIP 78664
Phone 512 740-8993
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/1/2025
Certificate Expiration Date 9/30/2027
Facility Type Physician Office
Lab Director LITTY R. VADAKKAN

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