45D2014261 CLIA NUMBER - LAKE COUNTRY FAMILY MEDICINE, PA

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Laboratory Demographics

CLIA Number: 45D2014261

Facility Name: LAKE COUNTRY FAMILY MEDICINE, PA

Facility Address:
8465 BOAT CLUB ROAD, SUITE 115
FORT WORTH, TX
ZIP 76179
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Facility Phone Number: 817 260-0535

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1629392063

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	45D2014261
LAB Type	Physician Office
Facility Name	LAKE COUNTRY FAMILY MEDICINE, PA
Street	8465 BOAT CLUB ROAD, SUITE 115
City	FORT WORTH
State	TX
ZIP	76179
Phone	817 260-0535
CertificateType	4
CertificateEffectiveDate	10/5/2022
CertificateExpirationDate	10/4/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024