45D2070058 CLIA NUMBER - MW WELLNESS V, LLC

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Laboratory Demographics

CLIA Number: 45D2070058

Facility Name: MW WELLNESS V, LLC

Facility Address:
1125 DAVIS BLVD SUITE 100
SOUTHLAKE, TX
ZIP 76092
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Facility Phone Number: 817 488-1956

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1528506730

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

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
CertificateType	4
CertificateEffectiveDate	12/10/2023
CertificateExpirationDate	12/9/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024