45D2191410 CLIA NUMBER - FORMULA WELLNESS PARK CITIES

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Laboratory Demographics

CLIA Number: 45D2191410

Facility Name: FORMULA WELLNESS PARK CITIES

Facility Address:
4342 LOVERS LN
DALLAS, TX
ZIP 75225
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Facility Phone Number: 214 931-9443

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1346608536

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	45D2191410
LAB Type	Physician Office
Facility Name	FORMULA WELLNESS PARK CITIES
Street	4342 LOVERS LN
City	DALLAS
State	TX
ZIP	75225
Phone	214 931-9443
CertificateType	4
CertificateEffectiveDate	6/29/2023
CertificateExpirationDate	6/28/2025
FacilityType	Waiver

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