45D2321813 CLIA NUMBER - BLOOM MEDICAL CARE LLC

Laboratory Demographics

  • CLIA Code: 45D2321813
  • Facility Name: BLOOM MEDICAL CARE LLC
  • Facility Address: 10107 LOUETTA RD., SUITE 105
    HOUSTON, TX
    ZIP 77070
  • Facility Phone: 210 992-2654
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EVERALD O. MANNING
  • NPI Number: 1497451884
  • Taxonomy: 363LP2300X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 45D2321813
LAB Type Physician Office
Facility Name BLOOM MEDICAL CARE LLC
Street 10107 LOUETTA RD., SUITE 105
City HOUSTON
State TX
ZIP 77070
Phone 210 992-2654
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/10/2025
Certificate Expiration Date 4/9/2027
Facility Type Physician Office
Lab Director EVERALD O. MANNING

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