45D2270439 CLIA NUMBER - XTRA CARE CLINIC, LLC

Laboratory Demographics

  • CLIA Code: 45D2270439
  • Facility Name: XTRA CARE CLINIC, LLC
  • Facility Address: 1050 FOREST LN SUITE 154B
    DALLAS, TX
    ZIP 75243
  • Facility Phone: 972 365-0084
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: IMAH M. EVELYNE
  • NPI Number: 1699440214
  • Taxonomy: 363LP0808X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 45D2270439
LAB Type Practitioner Other
Facility Name XTRA CARE CLINIC, LLC
Street 1050 FOREST LN SUITE 154B
City DALLAS
State TX
ZIP 75243
Phone 972 365-0084
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/14/2024
Certificate Expiration Date 10/13/2026
Facility Type Practitioner Other
Lab Director IMAH M. EVELYNE

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