45D2267362 CLIA NUMBER - METHODIST SOUTHLAKE

Laboratory Demographics

  • CLIA Code: 45D2267362
  • Facility Name: METHODIST SOUTHLAKE
  • Facility Address: 3055 W SOUTHLAKE BLVD
    SOUTHLAKE, TX
    ZIP 76092
  • Facility Phone: 469 204-6980
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LISA M. MAEHARA
  • NPI Number: 1568818417
  • Taxonomy: 282N00000X - General Acute Care Hospital

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CLIA Record

Field Name Field Value
CLIA Number 45D2267362
LAB Type Physician Office
Facility Name METHODIST SOUTHLAKE
Street 3055 W SOUTHLAKE BLVD
City SOUTHLAKE
State TX
ZIP 76092
Phone 469 204-6980
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/24/2024
Certificate Expiration Date 8/23/2026
Facility Type Physician Office
Lab Director LISA M. MAEHARA

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This page was last updated on: 6/4/2025