45D2070058 CLIA NUMBER - MW WELLNESS V, LLC

Laboratory Demographics

  • CLIA Code: 45D2070058
  • Facility Name: MW WELLNESS V, LLC
  • Facility Address: 1125 DAVIS BLVD SUITE 100
    SOUTHLAKE, TX
    ZIP 76092
  • Facility Phone: 817 488-1956
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHRIS GUY YIANTSOU
  • NPI Number: 1528506730
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D2070058
LAB Type Physician Office
Facility Name MW WELLNESS V, LLC
Street 1125 DAVIS BLVD SUITE 100
City SOUTHLAKE
State TX
ZIP 76092
Phone 817 488-1956
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/10/2023
Certificate Expiration Date 12/9/2025
Facility Type Physician Office
Lab Director CHRIS GUY YIANTSOU

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