45D2254539 CLIA NUMBER - JPS 1350 MEDICAL SPECIALITY CLINIC

Laboratory Demographics

  • CLIA Code: 45D2254539
  • Facility Name: JPS 1350 MEDICAL SPECIALITY CLINIC
  • Facility Address: 1350S MAIN ST 3RD FLOOR SUITE 3200
    FORT WORTH, TX
    ZIP 76104
  • Facility Phone: 817 702-3509
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: SHILPA MADADI
  • NPI Number: 1215248265
  • Taxonomy: 282N00000X - General Acute Care Hospital

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CLIA Record

Field Name Field Value
CLIA Number 45D2254539
LAB Type Community Clinic
Facility Name JPS 1350 MEDICAL SPECIALITY CLINIC
Street 1350S MAIN ST 3RD FLOOR SUITE 3200
City FORT WORTH
State TX
ZIP 76104
Phone 817 702-3509
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/4/2024
Certificate Expiration Date 3/3/2026
Facility Type Community Clinic
Lab Director SHILPA MADADI

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This page was last updated on: 3/20/2025