45D2259929 CLIA NUMBER - CENTRUM MEDICAL GROUP, PLLC

Laboratory Demographics

  • CLIA Code: 45D2259929
  • Facility Name: CENTRUM MEDICAL GROUP, PLLC
  • Facility Address: 17515 SPRING CYPRESS, SUITE 1
    CYPRESS, TX
    ZIP 77429
  • Facility Phone: 484 640-3643
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AYESHA SULTANA KHAN
  • NPI Number: 1023696770
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D2259929
LAB Type Physician Office
Facility Name CENTRUM MEDICAL GROUP, PLLC
Street 17515 SPRING CYPRESS, SUITE 1
City CYPRESS
State TX
ZIP 77429
Phone 484 640-3643
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/12/2024
Certificate Expiration Date 5/11/2026
Facility Type Physician Office
Lab Director AYESHA SULTANA KHAN

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