45D2156626 CLIA NUMBER - PROMUS DIAGNOSTICS, LLC

Laboratory Demographics

  • CLIA Code: 45D2156626
  • Facility Name: PROMUS DIAGNOSTICS, LLC
  • Facility Address: 525 S KIMBALL AVE
    SOUTHLAKE, TX
    ZIP 76092
  • Facility Phone: 817 778-9210
  • Facility Type: Independent
  • Facility Type: Accreditation
  • Lab Director: DR. NICOLE A. MASSOLL
  • NPI Number: 1033680681
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 45D2156626
LAB Type Independent
Facility Name PROMUS DIAGNOSTICS, LLC
Street 525 S KIMBALL AVE
City SOUTHLAKE
State TX
ZIP 76092
Phone 817 778-9210
Certificate Type Certificate of Accreditation
Certificate Type Description This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.
Certificate Effective Date 12/31/2023
Certificate Expiration Date 12/30/2025
Facility Type Independent
Lab Director DR. NICOLE A. MASSOLL

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