45D2300577 CLIA NUMBER - COVENANT MEDICAL GROUP-WESTFALL

Laboratory Demographics

CLIA Number: 45D2300577

Facility Name: COVENANT MEDICAL GROUP-WESTFALL

Facility Address:
4102-24TH SUITE 101 (NORTH)
LUBBOCK, TX
ZIP 79410
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Facility Phone Number: 806 725-9043

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1457401036

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D2300577
LAB Type	Physician Office
Facility Name	COVENANT MEDICAL GROUP-WESTFALL
Street	4102-24TH SUITE 101 (NORTH)
City	LUBBOCK
State	TX
ZIP	79410
Phone	806 725-9043
CertificateType	4
CertificateEffectiveDate	3/13/2024
CertificateExpirationDate	3/12/2026
FacilityType	Waiver

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