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

Laboratory Demographics

CLIA Number: 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
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Facility Phone Number: 254 537-6900

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1093708679

Taxonomy: 282N00000X - General Acute Care Hospital
An acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a wide population group. The hospital treats patients in an acute phase of illness or injury, characterized by a single episode or a fairly short duration, from which the patient returns to his or her normal or previous level of activity.

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
CertificateType 4
CertificateEffectiveDate 6/8/2023
CertificateExpirationDate 6/7/2025
FacilityType Waiver

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