45D2292202 CLIA NUMBER - RESILIENT PLASTIC SURGERY, PLLC

Laboratory Demographics

  • CLIA Code: 45D2292202
  • Facility Name: RESILIENT PLASTIC SURGERY, PLLC
  • Facility Address: 800 8TH AVENUE SUITE 116
    FORT WORTH, TX
    ZIP 76104
  • Facility Phone: 817 335-6363
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHELLE M. SOUTHARD
  • NPI Number: 1932807682
  • Taxonomy: 2086S0122X - Surgery

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CLIA Record

Field Name Field Value
CLIA Number 45D2292202
LAB Type Physician Office
Facility Name RESILIENT PLASTIC SURGERY, PLLC
Street 800 8TH AVENUE SUITE 116
City FORT WORTH
State TX
ZIP 76104
Phone 817 335-6363
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/20/2025
Certificate Expiration Date 10/19/2027
Facility Type Physician Office
Lab Director MICHELLE M. SOUTHARD

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