45D2134862 CLIA NUMBER - BAYLOR SCOTT & WHITE PRIMARY CARE MANSFIELD

Laboratory Demographics

  • CLIA Code: 45D2134862
  • Facility Name: BAYLOR SCOTT & WHITE PRIMARY CARE MANSFIELD
  • Facility Address: 1776 N US 287 SUITE 220
    MANSFIELD, TX
    ZIP 76063
  • Facility Phone: 817 912-8980
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: OMOLOLU OMOWANILE
  • NPI Number: 1992037352
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D2134862
LAB Type Physician Office
Facility Name BAYLOR SCOTT & WHITE PRIMARY CARE MANSFIELD
Street 1776 N US 287 SUITE 220
City MANSFIELD
State TX
ZIP 76063
Phone 817 912-8980
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/10/2025
Certificate Expiration Date 8/9/2027
Facility Type Physician Office
Lab Director OMOLOLU OMOWANILE

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