Organization
MIDLAND CLIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL EARL WATERS (ADMINISTRATOR)
(432) 570-4475
Entity
Organization
Contact information
Practice address
808 W INDIANA AVE, MIDLAND, TX 79701-6610
(432) 570-4475
(432) 686-3960
Mailing address
808 W INDIANA AVE, MIDLAND, TX 79701-6610
(432) 570-4475
(432) 686-3960
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
CLIA 1123
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CL1123
CLIA
TX
Enumeration date
09/10/2010
Last updated
09/10/2010
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