45D1012728 CLIA NUMBER - PEDIATRIC ASSOCIATES 10TH STREET

Laboratory Demographics

  • CLIA Code: 45D1012728
  • Facility Name: PEDIATRIC ASSOCIATES 10TH STREET
  • Facility Address: 1718 10TH STREET
    WICHITA FALLS, TX
    ZIP 76301
  • Facility Phone: 940 761-2229
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: ELLAHEH EBRAHIM
  • NPI Number: 1871537431
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 45D1012728
LAB Type Federally Qualified Health Center
Facility Name PEDIATRIC ASSOCIATES 10TH STREET
Street 1718 10TH STREET
City WICHITA FALLS
State TX
ZIP 76301
Phone 940 761-2229
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/19/2025
Certificate Expiration Date 5/18/2027
Facility Type Federally Qualified Health Center
Lab Director ELLAHEH EBRAHIM

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