45D1036103 CLIA NUMBER - CENTER FOR PEDIATRIC SURGERY DBA COOKS CHILDRENS PEDIATRIC SURGERY

Laboratory Demographics

  • CLIA Code: 45D1036103
  • Facility Name: CENTER FOR PEDIATRIC SURGERY DBA COOKS CHILDRENS PEDIATRIC SURGERY
  • Facility Address: 4200 W UNIVERSITY DRIVE SUITE 110
    PROSPER, TX
    ZIP 75078
  • Facility Phone: 972 300-0215
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: JEANNE G. FANONI
  • NPI Number: 1801847728
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D1036103
LAB Type Ambulatory Surgery Center
Facility Name CENTER FOR PEDIATRIC SURGERY DBA COOKS CHILDRENS PEDIATRIC SURGERY
Street 4200 W UNIVERSITY DRIVE SUITE 110
City PROSPER
State TX
ZIP 75078
Phone 972 300-0215
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/1/2025
Certificate Expiration Date 6/30/2027
Facility Type Ambulatory Surgery Center
Lab Director JEANNE G. FANONI

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