45D2146780 CLIA NUMBER - METHODIST CONVENIENT CARE CAMPUS SGP

Laboratory Demographics

  • CLIA Code: 45D2146780
  • Facility Name: METHODIST CONVENIENT CARE CAMPUS SGP
  • Facility Address: 4560 LAKE RIDGE PARKWAY SUITE 200
    GRAND PRAIRIE, TX
    ZIP 75052
  • Facility Phone: 972 263-5272
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ERIC BEADLE
  • NPI Number: 1558762690
  • Taxonomy: 261QU0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D2146780
LAB Type Physician Office
Facility Name METHODIST CONVENIENT CARE CAMPUS SGP
Street 4560 LAKE RIDGE PARKWAY SUITE 200
City GRAND PRAIRIE
State TX
ZIP 75052
Phone 972 263-5272
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/6/2024
Certificate Expiration Date 1/5/2026
Facility Type Physician Office
Lab Director ERIC BEADLE

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