45D1106200 CLIA NUMBER - ALLIANCE PEDIATRICS

Laboratory Demographics

  • CLIA Code: 45D1106200
  • Facility Name: ALLIANCE PEDIATRICS
  • Facility Address: 12461 TIMBERLAND BLVD, SUITE 309
    FORT WORTH, TX
    ZIP 76244
  • Facility Phone: 817 741-5437
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BRUCE D. MARTIN, MD
  • NPI Number: 1689922627
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 45D1106200
LAB Type Physician Office
Facility Name ALLIANCE PEDIATRICS
Street 12461 TIMBERLAND BLVD, SUITE 309
City FORT WORTH
State TX
ZIP 76244
Phone 817 741-5437
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/31/2024
Certificate Expiration Date 5/30/2026
Facility Type Physician Office
Lab Director BRUCE D. MARTIN, MD

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