45D0482485 CLIA NUMBER - WYRICK DERMATOLOGY ASSN

Laboratory Demographics

  • CLIA Code: 45D0482485
  • Facility Name: WYRICK DERMATOLOGY ASSN
  • Facility Address: 3333 POTOMAC AVENUE
    TEXARKANA, TX
    ZIP 75503
  • Facility Phone: 903 792-3787
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: WALTER WYRICK JR MD
  • NPI Number: 1619977295
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D0482485
LAB Type Physician Office
Facility Name WYRICK DERMATOLOGY ASSN
Street 3333 POTOMAC AVENUE
City TEXARKANA
State TX
ZIP 75503
Phone 903 792-3787
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director WALTER WYRICK JR MD

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