45D2251743 CLIA NUMBER - CENTRUM MEDICAL GROUP, PLLC

Laboratory Demographics

  • CLIA Code: 45D2251743
  • Facility Name: CENTRUM MEDICAL GROUP, PLLC
  • Facility Address: 7664 MCCART AVE
    FORT WORTH, TX
    ZIP 76133
  • Facility Phone: 305 266-2929
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AYESHA S. KHAN
  • NPI Number: 1942953211
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 45D2251743
LAB Type Physician Office
Facility Name CENTRUM MEDICAL GROUP, PLLC
Street 7664 MCCART AVE
City FORT WORTH
State TX
ZIP 76133
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