45D2166939 CLIA NUMBER - MELVILLE MEDICINE, PLLC

Laboratory Demographics

  • CLIA Code: 45D2166939
  • Facility Name: MELVILLE MEDICINE, PLLC
  • Facility Address: 1545 EAST SOUTHLAKE BLVD SUITE 110
    SOUTHLAKE, TX
    ZIP 76092
  • Facility Phone: 817 767-2110
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DANIEL E. MELVILLE
  • NPI Number: 1043873771
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D2166939
LAB Type Physician Office
Facility Name MELVILLE MEDICINE, PLLC
Street 1545 EAST SOUTHLAKE BLVD SUITE 110
City SOUTHLAKE
State TX
ZIP 76092
Phone 817 767-2110
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/30/2025
Certificate Expiration Date 5/29/2027
Facility Type Physician Office
Lab Director DANIEL E. MELVILLE

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