45D2301053 CLIA NUMBER - ENRICHED LIFE MEDICAL

Laboratory Demographics

  • CLIA Code: 45D2301053
  • Facility Name: ENRICHED LIFE MEDICAL
  • Facility Address: 2412 WEST MAIN STREET
    GUN BARREL CITY, TX
    ZIP 75156
  • Facility Phone: 903 309-9373
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JON RICH
  • NPI Number: 1043079742
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D2301053
LAB Type Physician Office
Facility Name ENRICHED LIFE MEDICAL
Street 2412 WEST MAIN STREET
City GUN BARREL CITY
State TX
ZIP 75156
Phone 903 309-9373
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/20/2024
Certificate Expiration Date 3/19/2026
Facility Type Physician Office
Lab Director JON RICH

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