45D2162604 CLIA NUMBER - EPIPHANY DERMATOLOGY, PA

Laboratory Demographics

  • CLIA Code: 45D2162604
  • Facility Name: EPIPHANY DERMATOLOGY, PA
  • Facility Address: 206 DENTON DR
    ROANOKE, TX
    ZIP 76262
  • Facility Phone: 682 237-2271
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: CHRISTOPHER K. FULLER
  • NPI Number: 1598403156
  • Taxonomy: 2355S0801X - Specialist/Technologist

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CLIA Record

Field Name Field Value
CLIA Number 45D2162604
LAB Type Physician Office
Facility Name EPIPHANY DERMATOLOGY, PA
Street 206 DENTON DR
City ROANOKE
State TX
ZIP 76262
Phone 682 237-2271
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 11/6/2023
Certificate Expiration Date 11/5/2025
Facility Type Physician Office
Lab Director CHRISTOPHER K. FULLER

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