45D2192067 CLIA NUMBER - LBU HEALTH CENTER SOUTH

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Laboratory Demographics

CLIA Number: 45D2192067

Facility Name: LBU HEALTH CENTER SOUTH

Facility Address:
5787 S HAMPTON RD SUITE 365
DALLAS, TX
ZIP 75232
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Facility Phone Number: 214 540-0300

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1104476431

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D2192067
LAB Type	Federally Qualified Health Center
Facility Name	LBU HEALTH CENTER SOUTH
Street	5787 S HAMPTON RD SUITE 365
City	DALLAS
State	TX
ZIP	75232
Phone	214 540-0300
CertificateType	4
CertificateEffectiveDate	9/3/2022
CertificateExpirationDate	9/2/2024
FacilityType	Waiver

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