45D2135462 CLIA NUMBER - BAYLOR SCOTT & WHITE CLINIC-TEMPLE PROFESSIONAL PLAZA II

Laboratory Demographics

  • CLIA Code: 45D2135462
  • Facility Name: BAYLOR SCOTT & WHITE CLINIC-TEMPLE PROFESSIONAL PLAZA II
  • Facility Address: 1713 SW H K DODGEN LOOP STE 100
    TEMPLE, TX
    ZIP 76502
  • Facility Phone: (254) 724-2314
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: RUSSELL EUGENE FOTHERGILL
  • NPI Number: 1811371784
  • Taxonomy: 282N00000X - General Acute Care Hospital

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 45D2135462
LAB Type Physician Office
Facility Name BAYLOR SCOTT & WHITE CLINIC-TEMPLE PROFESSIONAL PLAZA II
Street 1713 SW H K DODGEN LOOP STE 100
City TEMPLE
State TX
ZIP 76502
Phone 2547242314
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 8/22/2025
Certificate Expiration Date 8/21/2027
Facility Type Physician Office
Lab Director RUSSELL EUGENE FOTHERGILL

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

This page was last updated on: 5/18/2026