45D2110156 CLIA NUMBER - OCCUMED PLUS-GRAND PRAIRIE, LLC

Laboratory Demographics

  • CLIA Code: 45D2110156
  • Facility Name: OCCUMED PLUS-GRAND PRAIRIE, LLC
  • Facility Address: 805 W CARRIER PKWY, SUITE 260
    GRAND PRAIRIE, TX
    ZIP 75050
  • Facility Phone: 972 494-1419
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PHILLIP A. CASHILOLA
  • NPI Number: 1174962823
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 45D2110156
LAB Type Physician Office
Facility Name OCCUMED PLUS-GRAND PRAIRIE, LLC
Street 805 W CARRIER PKWY, SUITE 260
City GRAND PRAIRIE
State TX
ZIP 75050
Phone 972 494-1419
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/9/2024
Certificate Expiration Date 3/8/2026
Facility Type Physician Office
Lab Director PHILLIP A. CASHILOLA

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