45D2168831 CLIA NUMBER - DOMAIN SURGICAL, LLC

Laboratory Demographics

  • CLIA Code: 45D2168831
  • Facility Name: DOMAIN SURGICAL, LLC
  • Facility Address: 2300 WOLFLIN AVE
    AMARILLO, TX
    ZIP 79109
  • Facility Phone: 806 398-2540
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: JEREMY M. GIBSON-ROARK
  • NPI Number: 1780167866
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D2168831
LAB Type Ambulatory Surgery Center
Facility Name DOMAIN SURGICAL, LLC
Street 2300 WOLFLIN AVE
City AMARILLO
State TX
ZIP 79109
Phone 806 398-2540
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/10/2025
Certificate Expiration Date 7/9/2027
Facility Type Ambulatory Surgery Center
Lab Director JEREMY M. GIBSON-ROARK

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