45D2268437 CLIA NUMBER - FORMA MEDICAL GROUP DBA DALLAS DIAGNOSTIC CENTER

Laboratory Demographics

  • CLIA Code: 45D2268437
  • Facility Name: FORMA MEDICAL GROUP DBA DALLAS DIAGNOSTIC CENTER
  • Facility Address: 570 S EDMONDS LANE UNIT 104 / 106B
    LEWISVILLE, TX
    ZIP 75067
  • Facility Phone: 469 464-4522
  • Facility Type: Independent
  • Facility Type: Accreditation
  • Lab Director: DR. RODOLFO J. NUDELMAN
  • NPI Number: 1073227179
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 45D2268437
LAB Type Independent
Facility Name FORMA MEDICAL GROUP DBA DALLAS DIAGNOSTIC CENTER
Street 570 S EDMONDS LANE UNIT 104 / 106B
City LEWISVILLE
State TX
ZIP 75067
Phone 469 464-4522
Certificate Type Certificate of Accreditation
Certificate Type Description This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.
Certificate Effective Date 2/20/2024
Certificate Expiration Date 2/19/2026
Facility Type Independent
Lab Director DR. RODOLFO J. NUDELMAN

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