45D2095813 CLIA NUMBER - UT SOUTHWESTERN MED CENTER CLINICAL LABORATORY SER MONCRIEF CANCER INSTITUTE

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Laboratory Demographics

CLIA Number: 45D2095813

Facility Name: UT SOUTHWESTERN MED CENTER CLINICAL LABORATORY SER MONCRIEF CANCER INSTITUTE

Facility Address:
400 W MAGNOLIA AVE, STE 2104
FORT WORTH, TX
ZIP 76104
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Facility Phone Number: 214 633-4913

Facility Type: Other - SATELLITE LAB IN CLINIC

Certificate Type: Accreditation

NPI Number: 1134443765

Taxonomy: 261QM2500X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).

CLIA Record

Field Name	Field Value
CLIA Number	45D2095813
LAB Type	Other - SATELLITE LAB IN CLINIC
Facility Name	UT SOUTHWESTERN MED CENTER CLINICAL LABORATORY SER MONCRIEF CANCER INSTITUTE
Street	400 W MAGNOLIA AVE, STE 2104
City	FORT WORTH
State	TX
ZIP	76104
Phone	214 633-4913
CertificateType	1
CertificateEffectiveDate	3/9/2024
CertificateExpirationDate	3/8/2026
FacilityType	Accreditation

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