45D2251739 CLIA NUMBER - CENTRUM MEDICAL GROUP, PLLC

Laboratory Demographics

  • CLIA Code: 45D2251739
  • Facility Name: CENTRUM MEDICAL GROUP, PLLC
  • Facility Address: 2223 S BUCKNER BLVD
    DALLAS, TX
    ZIP 75227
  • Facility Phone: 305 266-2929
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AYESHA S. KHAN
  • NPI Number: 1043963317
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 45D2251739
LAB Type Physician Office
Facility Name CENTRUM MEDICAL GROUP, PLLC
Street 2223 S BUCKNER BLVD
City DALLAS
State TX
ZIP 75227
Phone 305 266-2929
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/4/2024
Certificate Expiration Date 2/3/2026
Facility Type Physician Office
Lab Director AYESHA S. KHAN

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