45D2018411 CLIA NUMBER - KELLER DERMATOLOGY, PA

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Laboratory Demographics

CLIA Number: 45D2018411

Facility Name: KELLER DERMATOLOGY, PA

Facility Address:
601 S MAIN STREET, SUITE 115
KELLER, TX
ZIP 76248
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Facility Phone Number: 817 753-6633

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1588985683

Taxonomy: 261QM2500X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).

CLIA Record

Field Name	Field Value
CLIA Number	45D2018411
LAB Type	Physician Office
Facility Name	KELLER DERMATOLOGY, PA
Street	601 S MAIN STREET, SUITE 115
City	KELLER
State	TX
ZIP	76248
Phone	817 753-6633
CertificateType	3
CertificateEffectiveDate	1/5/2023
CertificateExpirationDate	1/4/2025
FacilityType	PPMP

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