45D2104452 CLIA NUMBER - MEDICAL CITY SURGERY CENTER SOUTHLAKE

Laboratory Demographics

  • CLIA Code: 45D2104452
  • Facility Name: MEDICAL CITY SURGERY CENTER SOUTHLAKE
  • Facility Address: 2815 W SOUTHLAKE BLVD SUITE 100
    SOUTHLAKE, TX
    ZIP 76092
  • Facility Phone: 817 431-3200
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: RONA J. FELLO
  • NPI Number: 1821471640
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D2104452
LAB Type Ambulatory Surgery Center
Facility Name MEDICAL CITY SURGERY CENTER SOUTHLAKE
Street 2815 W SOUTHLAKE BLVD SUITE 100
City SOUTHLAKE
State TX
ZIP 76092
Phone 817 431-3200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/4/2023
Certificate Expiration Date 11/3/2025
Facility Type Ambulatory Surgery Center
Lab Director RONA J. FELLO

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