45D2091398 CLIA NUMBER - EPIPHANY DERMATOLOGY PA

Laboratory Demographics

  • CLIA Code: 45D2091398
  • Facility Name: EPIPHANY DERMATOLOGY PA
  • Facility Address: 211 N INDUSTRIAL DRIVE
    WACO, TX
    ZIP 76710
  • Facility Phone: 254 424-9127
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: DR. CARY D. CHISHOLM
  • NPI Number: 1043615263
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 45D2091398
LAB Type Physician Office
Facility Name EPIPHANY DERMATOLOGY PA
Street 211 N INDUSTRIAL DRIVE
City WACO
State TX
ZIP 76710
Phone 254 424-9127
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 10/31/2024
Certificate Expiration Date 10/30/2026
Facility Type Physician Office
Lab Director DR. CARY D. CHISHOLM

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