45D1106188 CLIA NUMBER - PECAN TREE PEDIATRICS

Laboratory Demographics

  • CLIA Code: 45D1106188
  • Facility Name: PECAN TREE PEDIATRICS
  • Facility Address: 201 I-30 EAST SUITE 100
    ROCKWALL, TX
    ZIP 75087
  • Facility Phone: 972 772-3100
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CASEY E. DRAKE
  • NPI Number: 1073802724
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 45D1106188
LAB Type Physician Office
Facility Name PECAN TREE PEDIATRICS
Street 201 I-30 EAST SUITE 100
City ROCKWALL
State TX
ZIP 75087
Phone 972 772-3100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/5/2025
Certificate Expiration Date 4/4/2027
Facility Type Physician Office
Lab Director CASEY E. DRAKE

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