45D2049976 CLIA NUMBER - MONTICELLO DIAGNOSTIC IMAGING

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Laboratory Demographics

CLIA Number: 45D2049976

Facility Name: MONTICELLO DIAGNOSTIC IMAGING

Facility Address:
649 NE ALSBURY BLVD SUITE 101
BURLESON, TX
ZIP 76028
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Facility Phone Number: 817 295-5477

Facility Type: Other - IMAGING CENTER

Certificate Type: Waiver

NPI Number: 1033160015

Taxonomy: 2085R0202X - Radiology
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

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
CertificateType	4
CertificateEffectiveDate	10/26/2022
CertificateExpirationDate	10/25/2024
FacilityType	Waiver

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