45D2060948 CLIA NUMBER - ORTHOTX

Laboratory Demographics

  • CLIA Code: 45D2060948
  • Facility Name: ORTHOTX
  • Facility Address: 2535 IRA E WOODS AVENUE
    GRAPEVINE, TX
    ZIP 76051
  • Facility Phone: 817 481-2121
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL R. BRISENO
  • NPI Number: 1386979649
  • Taxonomy: 207RN0300X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D2060948
LAB Type Physician Office
Facility Name ORTHOTX
Street 2535 IRA E WOODS AVENUE
City GRAPEVINE
State TX
ZIP 76051
Phone 817 481-2121
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/20/2025
Certificate Expiration Date 6/19/2027
Facility Type Physician Office
Lab Director MICHAEL R. BRISENO

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