45D2291112 CLIA NUMBER - EAGLE MOUNTAIN HEALTHCARE

Laboratory Demographics

  • CLIA Code: 45D2291112
  • Facility Name: EAGLE MOUNTAIN HEALTHCARE
  • Facility Address: 807 SOUTHEAST PKWY
    AZLE, TX
    ZIP 76020
  • Facility Phone: 817 661-8197
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: HEATHER M. GRAYSON
  • NPI Number: 1508563578
  • Taxonomy: 363LP2300X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 45D2291112
LAB Type Physician Office
Facility Name EAGLE MOUNTAIN HEALTHCARE
Street 807 SOUTHEAST PKWY
City AZLE
State TX
ZIP 76020
Phone 817 661-8197
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/5/2025
Certificate Expiration Date 10/4/2027
Facility Type Physician Office
Lab Director HEATHER M. GRAYSON

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