45D2310419 CLIA NUMBER - PREMISE HEALTH OF TEXAS MEDICAL, PA

Laboratory Demographics

  • CLIA Code: 45D2310419
  • Facility Name: PREMISE HEALTH OF TEXAS MEDICAL, PA
  • Facility Address: 1801 GULFWAY DRIVE
    PORT ARTHUR, TX
    ZIP 77640
  • Facility Phone: 409 985-1819
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LAWRENCE SANDERS
  • NPI Number: 1174350771
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D2310419
LAB Type Physician Office
Facility Name PREMISE HEALTH OF TEXAS MEDICAL, PA
Street 1801 GULFWAY DRIVE
City PORT ARTHUR
State TX
ZIP 77640
Phone 409 985-1819
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/4/2024
Certificate Expiration Date 9/3/2026
Facility Type Physician Office
Lab Director LAWRENCE SANDERS

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