45D2212420 CLIA NUMBER - GRACE AMBULATORY SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 45D2212420
  • Facility Name: GRACE AMBULATORY SURGERY CENTER
  • Facility Address: 470 E STATE HWY 114
    SOUTHLAKE, TX
    ZIP 76092
  • Facility Phone: 214 450-9926
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: ERIN PRICE
  • NPI Number: 1083229173
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D2212420
LAB Type Ambulatory Surgery Center
Facility Name GRACE AMBULATORY SURGERY CENTER
Street 470 E STATE HWY 114
City SOUTHLAKE
State TX
ZIP 76092
Phone 214 450-9926
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/4/2025
Certificate Expiration Date 2/3/2027
Facility Type Ambulatory Surgery Center
Lab Director ERIN PRICE

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