45D2049976 CLIA NUMBER - MONTICELLO DIAGNOSTIC IMAGING

Laboratory Demographics

  • CLIA Code: 45D2049976
  • Facility Name: MONTICELLO DIAGNOSTIC IMAGING
  • Facility Address: 649 NE ALSBURY BLVD SUITE 101
    BURLESON, TX
    ZIP 76028
  • Facility Phone: 817 295-5477
  • Facility Type: Other - IMAGING CENTER
  • Facility Type: Waiver
  • Lab Director: PAUL MARSH
  • NPI Number: 1033160015
  • Taxonomy: 2085R0202X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 45D2049976
LAB Type Other - IMAGING CENTER
Facility Name MONTICELLO DIAGNOSTIC IMAGING
Street 649 NE ALSBURY BLVD SUITE 101
City BURLESON
State TX
ZIP 76028
Phone 817 295-5477
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/26/2024
Certificate Expiration Date 10/25/2026
Facility Type Other - IMAGING CENTER
Lab Director PAUL MARSH

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