45D2161999 CLIA NUMBER - SHANE GILLIAM, MD FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 45D2161999
  • Facility Name: SHANE GILLIAM, MD FAMILY MEDICINE
  • Facility Address: 205 E FREY ST SUITE 201
    STEPHENVILLE, TX
    ZIP 76401
  • Facility Phone: 254 965-2313
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LESLIE S. GILLIAM
  • NPI Number: 1891003802
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D2161999
LAB Type Physician Office
Facility Name SHANE GILLIAM, MD FAMILY MEDICINE
Street 205 E FREY ST SUITE 201
City STEPHENVILLE
State TX
ZIP 76401
Phone 254 965-2313
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/14/2025
Certificate Expiration Date 2/13/2027
Facility Type Physician Office
Lab Director LESLIE S. GILLIAM

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