45D2078890 CLIA NUMBER - PARAGON PLASTIC SURGERY

Laboratory Demographics

  • CLIA Code: 45D2078890
  • Facility Name: PARAGON PLASTIC SURGERY
  • Facility Address: 1101 MATLOCK ROAD
    MANSFIELD, TX
    ZIP 76063
  • Facility Phone: 817 473-2120
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: MARK A. BISHARA
  • NPI Number: 1578979902
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D2078890
LAB Type Ambulatory Surgery Center
Facility Name PARAGON PLASTIC SURGERY
Street 1101 MATLOCK ROAD
City MANSFIELD
State TX
ZIP 76063
Phone 817 473-2120
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/5/2024
Certificate Expiration Date 6/4/2026
Facility Type Ambulatory Surgery Center
Lab Director MARK A. BISHARA

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