45D2289552 CLIA NUMBER - MAGNOLIA FAMILY MEDICINE

Laboratory Demographics

CLIA Number: 45D2289552

Facility Name: MAGNOLIA FAMILY MEDICINE

Facility Address:
1205 GRAHAM DR
TOMBALL, TX
ZIP 77375
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Facility Phone Number: 281 356-1945

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1851549851

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D2289552
LAB Type	Physician Office
Facility Name	MAGNOLIA FAMILY MEDICINE
Street	1205 GRAHAM DR
City	TOMBALL
State	TX
ZIP	77375
Phone	281 356-1945
CertificateType	4
CertificateEffectiveDate	9/12/2023
CertificateExpirationDate	9/11/2025
FacilityType	Waiver

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