45D2123022 CLIA NUMBER - INTERNAL MEDICINE CARE GROUP, PA

Laboratory Demographics

  • CLIA Code: 45D2123022
  • Facility Name: INTERNAL MEDICINE CARE GROUP, PA
  • Facility Address: 1001 12TH AVE SUITE 120
    FORT WORTH, TX
    ZIP 76104
  • Facility Phone: 817 870-3627
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AASIA D. JANJUA
  • NPI Number: 1780133512
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D2123022
LAB Type Physician Office
Facility Name INTERNAL MEDICINE CARE GROUP, PA
Street 1001 12TH AVE SUITE 120
City FORT WORTH
State TX
ZIP 76104
Phone 817 870-3627
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/12/2024
Certificate Expiration Date 12/11/2026
Facility Type Physician Office
Lab Director AASIA D. JANJUA

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