45D1000844 CLIA NUMBER - MALCOLM X PEDIATRIC CLINIC

Laboratory Demographics

  • CLIA Code: 45D1000844
  • Facility Name: MALCOLM X PEDIATRIC CLINIC
  • Facility Address: 4432 MALCOLM X BLVD
    DALLAS, TX
    ZIP 75215
  • Facility Phone: 214 428-2010
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: RUTH E. GREER
  • NPI Number: 1518290469
  • Taxonomy: 363L00000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 45D1000844
LAB Type Community Clinic
Facility Name MALCOLM X PEDIATRIC CLINIC
Street 4432 MALCOLM X BLVD
City DALLAS
State TX
ZIP 75215
Phone 214 428-2010
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/15/2025
Certificate Expiration Date 4/14/2027
Facility Type Community Clinic
Lab Director RUTH E. GREER

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