45D0686536 CLIA NUMBER - FOSSIL CREEK FAMILY MEDICAL CENTER

Laboratory Demographics

  • CLIA Code: 45D0686536
  • Facility Name: FOSSIL CREEK FAMILY MEDICAL CENTER
  • Facility Address: 7510 NORTH BEACH STREET
    FORT WORTH, TX
    ZIP 76137
  • Facility Phone: 817 498-1818
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DAVID W. SIMONAK
  • NPI Number: 1992249239
  • Taxonomy: 1223G0001X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 45D0686536
LAB Type Physician Office
Facility Name FOSSIL CREEK FAMILY MEDICAL CENTER
Street 7510 NORTH BEACH STREET
City FORT WORTH
State TX
ZIP 76137
Phone 817 498-1818
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 7/7/2025
Certificate Expiration Date 7/6/2027
Facility Type Physician Office
Lab Director DAVID W. SIMONAK

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