45D2004258 CLIA NUMBER - DERMATOLOGY SOUTHWEST

Laboratory Demographics

  • CLIA Code: 45D2004258
  • Facility Name: DERMATOLOGY SOUTHWEST
  • Facility Address: 12001 SOUTH FREEWAY, SUITE 205
    BURLESON, TX
    ZIP 76028
  • Facility Phone: 817 568-0500
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: BASEM M. CHAKER
  • NPI Number: 1922143544
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 45D2004258
LAB Type Physician Office
Facility Name DERMATOLOGY SOUTHWEST
Street 12001 SOUTH FREEWAY, SUITE 205
City BURLESON
State TX
ZIP 76028
Phone 817 568-0500
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 3/2/2024
Certificate Expiration Date 3/1/2026
Facility Type Physician Office
Lab Director BASEM M. CHAKER

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