45D2062620 CLIA NUMBER - VMD PRIMARY PROVIDERS OF SOUTH CENTRAL TEXAS EVERGREEN FP

Laboratory Demographics

  • CLIA Code: 45D2062620
  • Facility Name: VMD PRIMARY PROVIDERS OF SOUTH CENTRAL TEXAS EVERGREEN FP
  • Facility Address: 11207 N LAMAR BLVD, SUITE B
    AUSTIN, TX
    ZIP 78753
  • Facility Phone: 512 988-5355
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. YUN W. KIM
  • NPI Number: 1730404138
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D2062620
LAB Type Physician Office
Facility Name VMD PRIMARY PROVIDERS OF SOUTH CENTRAL TEXAS EVERGREEN FP
Street 11207 N LAMAR BLVD, SUITE B
City AUSTIN
State TX
ZIP 78753
Phone 512 988-5355
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/19/2023
Certificate Expiration Date 7/18/2025
Facility Type Physician Office
Lab Director DR. YUN W. KIM

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This page was last updated on: 3/20/2025