45D2275411 CLIA NUMBER - SEA BASE MEDICINE

Laboratory Demographics

  • CLIA Code: 45D2275411
  • Facility Name: SEA BASE MEDICINE
  • Facility Address: 1631 LANCASTER DR SUITE 330
    GRAPEVINE, TX
    ZIP 76051
  • Facility Phone: 817 953-3420
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOHN K. PAGE
  • NPI Number: 1790492734
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D2275411
LAB Type Physician Office
Facility Name SEA BASE MEDICINE
Street 1631 LANCASTER DR SUITE 330
City GRAPEVINE
State TX
ZIP 76051
Phone 817 953-3420
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/20/2025
Certificate Expiration Date 1/19/2027
Facility Type Physician Office
Lab Director JOHN K. PAGE

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