45D2257762 CLIA NUMBER - BEYOND WELLNESS TOTAL CARE, PLLC

Laboratory Demographics

CLIA Number: 45D2257762

Facility Name: BEYOND WELLNESS TOTAL CARE, PLLC

Facility Address:
450 HAWKINS RUN STE 4
MIDLOTHIAN, TX
ZIP 76065
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Facility Phone Number: 972 694-7899

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1568046175

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	45D2257762
LAB Type	Practitioner Other
Facility Name	BEYOND WELLNESS TOTAL CARE, PLLC
Street	450 HAWKINS RUN STE 4
City	MIDLOTHIAN
State	TX
ZIP	76065
Phone	972 694-7899
CertificateType	4
CertificateEffectiveDate	4/11/2024
CertificateExpirationDate	4/10/2026
FacilityType	Waiver

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