45D2100323 CLIA NUMBER - MY CARE FAMILY CLINIC

Laboratory Demographics

CLIA Number: 45D2100323

Facility Name: MY CARE FAMILY CLINIC

Facility Address:
1112 MAIN ST
GARLAND, TX
ZIP 75040
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Facility Phone Number: 469 573-9433

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1003209008

Taxonomy: 261QH0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D2100323
LAB Type	Practitioner Other
Facility Name	MY CARE FAMILY CLINIC
Street	1112 MAIN ST
City	GARLAND
State	TX
ZIP	75040
Phone	469 573-9433
CertificateType	4
CertificateEffectiveDate	8/12/2023
CertificateExpirationDate	8/11/2025
FacilityType	Waiver

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