45D2024029 CLIA NUMBER - DR FREDRIC PUCKETT PLLC

Laboratory Demographics

  • CLIA Code: 45D2024029
  • Facility Name: DR FREDRIC PUCKETT PLLC
  • Facility Address: 2203 W LAMPASAS ST, SUITE 111
    ENNIS, TX
    ZIP 75119
  • Facility Phone: 972 875-6200
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: FREDRIC C. PUCKETT
  • NPI Number: 1073748562
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D2024029
LAB Type Physician Office
Facility Name DR FREDRIC PUCKETT PLLC
Street 2203 W LAMPASAS ST, SUITE 111
City ENNIS
State TX
ZIP 75119
Phone 972 875-6200
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 5/6/2025
Certificate Expiration Date 5/5/2027
Facility Type Physician Office
Lab Director FREDRIC C. PUCKETT

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