45D0671191 CLIA NUMBER - BAYLOR SCOTT & WHITE FAMILY MEDICINE SOUTHWEST FORT WORTH

Laboratory Demographics

CLIA Number: 45D0671191

Facility Name: BAYLOR SCOTT & WHITE FAMILY MEDICINE SOUTHWEST FORT WORTH

Facility Address:
5701 BRYANT IRVIN ROAD SUITE 301
FORT WORTH, TX
ZIP 76132
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Facility Phone Number: 817 912-9800

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1275536328

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D0671191
LAB Type	Physician Office
Facility Name	BAYLOR SCOTT & WHITE FAMILY MEDICINE SOUTHWEST FORT WORTH
Street	5701 BRYANT IRVIN ROAD SUITE 301
City	FORT WORTH
State	TX
ZIP	76132
Phone	817 912-9800
CertificateType	4
CertificateEffectiveDate	7/22/2022
CertificateExpirationDate	7/21/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024