45D2139078 CLIA NUMBER - EVERGREEN TESTOSTERONE CLINIC & PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 45D2139078
  • Facility Name: EVERGREEN TESTOSTERONE CLINIC & PRIMARY CARE
  • Facility Address: 623 MATLOCK CENTER CIRCLE
    ARLINGTON, TX
    ZIP 76015
  • Facility Phone: 817 987-1127
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KEN G. WAMWRI
  • NPI Number: 1942710256
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D2139078
LAB Type Physician Office
Facility Name EVERGREEN TESTOSTERONE CLINIC & PRIMARY CARE
Street 623 MATLOCK CENTER CIRCLE
City ARLINGTON
State TX
ZIP 76015
Phone 817 987-1127
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/30/2023
Certificate Expiration Date 10/29/2025
Facility Type Physician Office
Lab Director KEN G. WAMWRI

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