45D2060957 CLIA NUMBER - ORTHOTX

Laboratory Demographics

  • CLIA Code: 45D2060957
  • Facility Name: ORTHOTX
  • Facility Address: 4501 HERITAGE TRACE PARKWAY, STE 101
    FORT WORTH, TX
    ZIP 76244
  • Facility Phone: 817 481-2121
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL R. BRISENO
  • NPI Number: 1124484233
  • Taxonomy: 261QE0002X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D2060957
LAB Type Physician Office
Facility Name ORTHOTX
Street 4501 HERITAGE TRACE PARKWAY, STE 101
City FORT WORTH
State TX
ZIP 76244
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: 6/4/2025