45D2175783 CLIA NUMBER - KATHLEEN A CLARK, MD PA

Laboratory Demographics

  • CLIA Code: 45D2175783
  • Facility Name: KATHLEEN A CLARK, MD PA
  • Facility Address: 5701 TIME SQUARE BLVD SUITE 220
    AMARILLO, TX
    ZIP 79119
  • Facility Phone: 806 350-7311
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KATHLEEN A. CLARK
  • NPI Number: 1083085385
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D2175783
LAB Type Physician Office
Facility Name KATHLEEN A CLARK, MD PA
Street 5701 TIME SQUARE BLVD SUITE 220
City AMARILLO
State TX
ZIP 79119
Phone 806 350-7311
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/2/2023
Certificate Expiration Date 12/1/2025
Facility Type Physician Office
Lab Director KATHLEEN A. CLARK

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