45D2283531 CLIA NUMBER - ASCENSION MEDICAL GROUP PROVIDENCE BOSQUE RIDGE PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 45D2283531
  • Facility Name: ASCENSION MEDICAL GROUP PROVIDENCE BOSQUE RIDGE PRIMARY CARE
  • Facility Address: 13701 W WOODWAY DR UNIT 2 ATTN AMY GREEN
    WOODWAY, TX
    ZIP 76712
  • Facility Phone: 254 537-6900
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CLINT MCHENRY
  • NPI Number: 1093708679
  • Taxonomy: 282N00000X - General Acute Care Hospital

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CLIA Record

Field Name Field Value
CLIA Number 45D2283531
LAB Type Physician Office
Facility Name ASCENSION MEDICAL GROUP PROVIDENCE BOSQUE RIDGE PRIMARY CARE
Street 13701 W WOODWAY DR UNIT 2 ATTN AMY GREEN
City WOODWAY
State TX
ZIP 76712
Phone 254 537-6900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/8/2025
Certificate Expiration Date 6/7/2027
Facility Type Physician Office
Lab Director CLINT MCHENRY

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