45D2148120 CLIA NUMBER - MAIN MEDICAL CLINIC

Laboratory Demographics

CLIA Number: 45D2148120

Facility Name: MAIN MEDICAL CLINIC

Facility Address:
2670 LAKE VISTA DR #101
LEWISVILLE, TX
ZIP 75067
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Facility Phone Number: 972 245-2876

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1144689373

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D2148120
LAB Type	Physician Office
Facility Name	MAIN MEDICAL CLINIC
Street	2670 LAKE VISTA DR #101
City	LEWISVILLE
State	TX
ZIP	75067
Phone	972 245-2876
CertificateType	4
CertificateEffectiveDate	5/3/2024
CertificateExpirationDate	5/2/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024