45D2155774 CLIA NUMBER - MED SOUTHWEST, PLLC

Laboratory Demographics

  • CLIA Code: 45D2155774
  • Facility Name: MED SOUTHWEST, PLLC
  • Facility Address: 5421 BASSWOOD BLVD SUITE 740
    FORT WORTH, TX
    ZIP 76137
  • Facility Phone: 703 847-8899
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOSEPH KAVANAGH
  • NPI Number: 1225223746
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 45D2155774
LAB Type Physician Office
Facility Name MED SOUTHWEST, PLLC
Street 5421 BASSWOOD BLVD SUITE 740
City FORT WORTH
State TX
ZIP 76137
Phone 703 847-8899
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/4/2024
Certificate Expiration Date 10/3/2026
Facility Type Physician Office
Lab Director JOSEPH KAVANAGH

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