45D2236731 CLIA NUMBER - S & J DIRECT PRIMARY CARE, PLLC DBA DURHAM DIRECT PRIMARY CARE

Laboratory Demographics

CLIA Number: 45D2236731

Facility Name: S & J DIRECT PRIMARY CARE, PLLC DBA DURHAM DIRECT PRIMARY CARE

Facility Address:
7655 COLGATE CT
FORT WORTH, TX
ZIP 76112
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Facility Phone Number: 817 966-8550

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1194493536

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D2236731
LAB Type	Physician Office
Facility Name	S & J DIRECT PRIMARY CARE, PLLC DBA DURHAM DIRECT PRIMARY CARE
Street	7655 COLGATE CT
City	FORT WORTH
State	TX
ZIP	76112
Phone	817 966-8550
CertificateType	4
CertificateEffectiveDate	9/20/2023
CertificateExpirationDate	9/19/2025
FacilityType	Waiver

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