45D2148686 CLIA NUMBER - ESSENCIA FAMILY PRACTICE & IMMEDIATE CARE CLINIC

Laboratory Demographics

CLIA Number: 45D2148686

Facility Name: ESSENCIA FAMILY PRACTICE & IMMEDIATE CARE CLINIC

Facility Address:
1509 W HEBRON PKWY SUITE 140
CARROLLTON, TX
ZIP 75010
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Facility Phone Number: 972 306-0016

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1013407451

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D2148686
LAB Type	Physician Office
Facility Name	ESSENCIA FAMILY PRACTICE & IMMEDIATE CARE CLINIC
Street	1509 W HEBRON PKWY SUITE 140
City	CARROLLTON
State	TX
ZIP	75010
Phone	972 306-0016
CertificateType	4
CertificateEffectiveDate	5/16/2024
CertificateExpirationDate	5/15/2026
FacilityType	Waiver

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