45D0485512 CLIA NUMBER - TY L GORE MD

Laboratory Demographics

  • CLIA Code: 45D0485512
  • Facility Name: TY L GORE MD
  • Facility Address: 214 SW 26TH AVE SUITE B
    MINERAL WELLS, TX
    ZIP 76067
  • Facility Phone: 817 325-9453
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TY L. GORE
  • NPI Number: 1578544698
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D0485512
LAB Type Physician Office
Facility Name TY L GORE MD
Street 214 SW 26TH AVE SUITE B
City MINERAL WELLS
State TX
ZIP 76067
Phone 817 325-9453
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/20/2024
Certificate Expiration Date 3/19/2026
Facility Type Physician Office
Lab Director TY L. GORE

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