45D1037313 CLIA NUMBER - BAYLOR SCOTT & WHITE FAMILY MEDICINE LAKE RIDGE

Laboratory Demographics

  • CLIA Code: 45D1037313
  • Facility Name: BAYLOR SCOTT & WHITE FAMILY MEDICINE LAKE RIDGE
  • Facility Address: 3095 KINGSWOOD BLVD SUITE 250
    GRAND PRAIRIE, TX
    ZIP 75052
  • Facility Phone: 972 817-1950
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARIA JUERGENS
  • NPI Number: 1831629526
  • Taxonomy: 282N00000X - General Acute Care Hospital

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CLIA Record

Field Name Field Value
CLIA Number 45D1037313
LAB Type Physician Office
Facility Name BAYLOR SCOTT & WHITE FAMILY MEDICINE LAKE RIDGE
Street 3095 KINGSWOOD BLVD SUITE 250
City GRAND PRAIRIE
State TX
ZIP 75052
Phone 972 817-1950
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/29/2023
Certificate Expiration Date 12/28/2025
Facility Type Physician Office
Lab Director MARIA JUERGENS

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