45D2227446 CLIA NUMBER - PROACTIVE MD BRAKEBUSH IRVING HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 45D2227446
  • Facility Name: PROACTIVE MD BRAKEBUSH IRVING HEALTH CENTER
  • Facility Address: 2230 E UNION BOWER RD
    IRVING, TX
    ZIP 75061
  • Facility Phone: 972 465-9686
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: KARALINE GORMLEY
  • NPI Number: 1649853771
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D2227446
LAB Type Practitioner Other
Facility Name PROACTIVE MD BRAKEBUSH IRVING HEALTH CENTER
Street 2230 E UNION BOWER RD
City IRVING
State TX
ZIP 75061
Phone 972 465-9686
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/11/2025
Certificate Expiration Date 6/10/2027
Facility Type Practitioner Other
Lab Director KARALINE GORMLEY

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