45D2285695 CLIA NUMBER - RODERICK D EKMARK MD, PA

Laboratory Demographics

  • CLIA Code: 45D2285695
  • Facility Name: RODERICK D EKMARK MD, PA
  • Facility Address: 101 WOODBRIDGE DR BLDG B STE 101 & 102
    LA VERNIA, TX
    ZIP 78121
  • Facility Phone: (830) 581-8027
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MELANIE K. CERVERA
  • NPI Number: 1063693398
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D2285695
LAB Type Physician Office
Facility Name RODERICK D EKMARK MD, PA
Street 101 WOODBRIDGE DR BLDG B STE 101 & 102
City LA VERNIA
State TX
ZIP 78121
Phone 8305818027
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/17/2025
Certificate Expiration Date 7/16/2027
Facility Type Physician Office
Lab Director MELANIE K. CERVERA

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This page was last updated on: 5/15/2026