45D2175768 CLIA NUMBER - PREMISE HEALTH OF TEXAS MEDICAL, PA

Laboratory Demographics

CLIA Number: 45D2175768

Facility Name: PREMISE HEALTH OF TEXAS MEDICAL, PA

Facility Address:
208 S AKARD ST SUITE PC-50
DALLAS, TX
ZIP 75202
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Facility Phone Number: 469 490-3119

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1093277071

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D2175768
LAB Type	Physician Office
Facility Name	PREMISE HEALTH OF TEXAS MEDICAL, PA
Street	208 S AKARD ST SUITE PC-50
City	DALLAS
State	TX
ZIP	75202
Phone	469 490-3119
CertificateType	4
CertificateEffectiveDate	12/2/2023
CertificateExpirationDate	12/1/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024