45D1024418 CLIA NUMBER - GREGORY J PHILLIPS MD

Laboratory Demographics

  • CLIA Code: 45D1024418
  • Facility Name: GREGORY J PHILLIPS MD
  • Facility Address: 724 PENNSYLVANIA AVE
    FORT WORTH, TX
    ZIP 76104
  • Facility Phone: 817 336-1200
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GREGORY J. PHILLIPS
  • NPI Number: 1508863838
  • Taxonomy: 207ZP0102X - Pathology

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CLIA Record

Field Name Field Value
CLIA Number 45D1024418
LAB Type Physician Office
Facility Name GREGORY J PHILLIPS MD
Street 724 PENNSYLVANIA AVE
City FORT WORTH
State TX
ZIP 76104
Phone 817 336-1200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/12/2024
Certificate Expiration Date 4/11/2026
Facility Type Physician Office
Lab Director GREGORY J. PHILLIPS

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