45D1060729 CLIA NUMBER - PPG HEALTH PA

Laboratory Demographics

  • CLIA Code: 45D1060729
  • Facility Name: PPG HEALTH PA
  • Facility Address: 500 LIPSCOMB STREET
    FORT WORTH, TX
    ZIP 76104
  • Facility Phone: 817 870-2616
  • Facility Type: Other - EXTESNSION OF OFFICE PRAC
  • Facility Type: Waiver
  • Lab Director: PETER V. NGUYEN
  • NPI Number: 1295736973
  • Taxonomy: 207RN0300X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D1060729
LAB Type Other - EXTESNSION OF OFFICE PRAC
Facility Name PPG HEALTH PA
Street 500 LIPSCOMB STREET
City FORT WORTH
State TX
ZIP 76104
Phone 817 870-2616
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/10/2024
Certificate Expiration Date 7/9/2026
Facility Type Other - EXTESNSION OF OFFICE PRAC
Lab Director PETER V. NGUYEN

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