45D2172247 CLIA NUMBER - WHOLELIFE AUTHENTIC CARE PROVIDER NETWORK

Laboratory Demographics

  • CLIA Code: 45D2172247
  • Facility Name: WHOLELIFE AUTHENTIC CARE PROVIDER NETWORK
  • Facility Address: 1000 BONNIE BRAE AVE
    FORT WORTH, TX
    ZIP 76111
  • Facility Phone: 817 838-5433
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JAMIE R. OBST
  • NPI Number: 1386200889
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 45D2172247
LAB Type Physician Office
Facility Name WHOLELIFE AUTHENTIC CARE PROVIDER NETWORK
Street 1000 BONNIE BRAE AVE
City FORT WORTH
State TX
ZIP 76111
Phone 817 838-5433
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 9/18/2025
Certificate Expiration Date 9/17/2027
Facility Type Physician Office
Lab Director JAMIE R. OBST

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