45D2168746 CLIA NUMBER - WHITE OAK FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 45D2168746
  • Facility Name: WHITE OAK FAMILY MEDICINE
  • Facility Address: 491 E OLD US HIGHWAY 80
    WHITE OAK, TX
    ZIP 75693
  • Facility Phone: 430 625-2001
  • Facility Type: Practitioner Other
  • Facility Type: Microscopy
  • Lab Director: KELLY JOHNSON
  • NPI Number: 1386143097
  • Taxonomy: 122300000X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 45D2168746
LAB Type Practitioner Other
Facility Name WHITE OAK FAMILY MEDICINE
Street 491 E OLD US HIGHWAY 80
City WHITE OAK
State TX
ZIP 75693
Phone 430 625-2001
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 7/9/2025
Certificate Expiration Date 7/8/2027
Facility Type Practitioner Other
Lab Director KELLY JOHNSON

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