45D2123202 CLIA NUMBER - LIBERTY DIAGNOSTICS, LLC

Laboratory Demographics

  • CLIA Code: 45D2123202
  • Facility Name: LIBERTY DIAGNOSTICS, LLC
  • Facility Address: 1001 12TH AVENUE SUITE 141
    FORT WORTH, TX
    ZIP 76104
  • Facility Phone: 972 402-5497
  • Facility Type: Physician Office
  • Facility Type: Accreditation
  • Lab Director: DR. KENT R. MITCHELL
  • NPI Number: 1528417003
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 45D2123202
LAB Type Physician Office
Facility Name LIBERTY DIAGNOSTICS, LLC
Street 1001 12TH AVENUE SUITE 141
City FORT WORTH
State TX
ZIP 76104
Phone 972 402-5497
Certificate Type Certificate of Accreditation
Certificate Type Description This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.
Certificate Effective Date 10/13/2025
Certificate Expiration Date 10/12/2027
Facility Type Physician Office
Lab Director DR. KENT R. MITCHELL

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