45D2064984 CLIA NUMBER - ADDISON INTERNAL MEDICINE, PA

Laboratory Demographics

  • CLIA Code: 45D2064984
  • Facility Name: ADDISON INTERNAL MEDICINE, PA
  • Facility Address: 16980 DALLAS PARKWAY STE 110
    DALLAS, TX
    ZIP 75248
  • Facility Phone: 972 733-3090
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TRI T. NGUYEN
  • NPI Number: 1043695695
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 45D2064984
LAB Type Physician Office
Facility Name ADDISON INTERNAL MEDICINE, PA
Street 16980 DALLAS PARKWAY STE 110
City DALLAS
State TX
ZIP 75248
Phone 972 733-3090
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/30/2025
Certificate Expiration Date 8/29/2027
Facility Type Physician Office
Lab Director TRI T. NGUYEN

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