45D2066054 CLIA NUMBER - WINDHAVEN ADOLESCENT & SPORTS MEDICINE

Laboratory Demographics

  • CLIA Code: 45D2066054
  • Facility Name: WINDHAVEN ADOLESCENT & SPORTS MEDICINE
  • Facility Address: 17051 N DALLAS PKWY SUITE 340
    ADDISON, TX
    ZIP 75001
  • Facility Phone: 972 473-8338
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LAURA H. SCALFANO
  • NPI Number: 1356542419
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D2066054
LAB Type Physician Office
Facility Name WINDHAVEN ADOLESCENT & SPORTS MEDICINE
Street 17051 N DALLAS PKWY SUITE 340
City ADDISON
State TX
ZIP 75001
Phone 972 473-8338
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/19/2023
Certificate Expiration Date 9/18/2025
Facility Type Physician Office
Lab Director LAURA H. SCALFANO

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This page was last updated on: 6/4/2025