45D2264049 CLIA NUMBER - INDEPENDENCE PEDIATRICS

Laboratory Demographics

  • CLIA Code: 45D2264049
  • Facility Name: INDEPENDENCE PEDIATRICS
  • Facility Address: 2305 S DAY ST # 108
    BRENHAM, TX
    ZIP 77833
  • Facility Phone: 979 203-3349
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DEREK L. HUSMANN
  • NPI Number: 1033140652
  • Taxonomy: 367500000X - Nurse Anesthetist, Certified Registered

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CLIA Record

Field Name Field Value
CLIA Number 45D2264049
LAB Type Physician Office
Facility Name INDEPENDENCE PEDIATRICS
Street 2305 S DAY ST # 108
City BRENHAM
State TX
ZIP 77833
Phone 979 203-3349
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/8/2024
Certificate Expiration Date 7/7/2026
Facility Type Physician Office
Lab Director DEREK L. HUSMANN

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