45D2263217 CLIA NUMBER - UNCHARTED TERRITORY HEALTH SERVICES

Laboratory Demographics

CLIA Number: 45D2263217

Facility Name: UNCHARTED TERRITORY HEALTH SERVICES

Facility Address:
1301 HAZEL ST
TEXARKANA, TX
ZIP 75501
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Facility Phone Number: 832 546-0643

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1841892551

Taxonomy: 363LP0808X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	45D2263217
LAB Type	Practitioner Other
Facility Name	UNCHARTED TERRITORY HEALTH SERVICES
Street	1301 HAZEL ST
City	TEXARKANA
State	TX
ZIP	75501
Phone	832 546-0643
CertificateType	4
CertificateEffectiveDate	6/24/2022
CertificateExpirationDate	6/23/2024
FacilityType	Waiver

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