45D2318275 CLIA NUMBER - FAIRMONT FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 45D2318275
  • Facility Name: FAIRMONT FAMILY PRACTICE
  • Facility Address: 400 W FAIRMONT PKWY STE B
    LA PORTE, TX
    ZIP 77571
  • Facility Phone: 346 222-7370
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ASHU SYAL
  • NPI Number: 1467276774
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D2318275
LAB Type Physician Office
Facility Name FAIRMONT FAMILY PRACTICE
Street 400 W FAIRMONT PKWY STE B
City LA PORTE
State TX
ZIP 77571
Phone 346 222-7370
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/7/2025
Certificate Expiration Date 2/6/2027
Facility Type Physician Office
Lab Director ASHU SYAL

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