45D1007246 CLIA NUMBER - ACUTE CARE AND FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 45D1007246
  • Facility Name: ACUTE CARE AND FAMILY MEDICINE
  • Facility Address: 803 E SOUTHLAKE BLVD SUITE 105
    SOUTHLAKE, TX
    ZIP 76092
  • Facility Phone: 817 416-2221
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: CHARLES B. RUSSEY
  • NPI Number: 1477651826
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D1007246
LAB Type Physician Office
Facility Name ACUTE CARE AND FAMILY MEDICINE
Street 803 E SOUTHLAKE BLVD SUITE 105
City SOUTHLAKE
State TX
ZIP 76092
Phone 817 416-2221
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 12/11/2024
Certificate Expiration Date 12/10/2026
Facility Type Physician Office
Lab Director CHARLES B. RUSSEY

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