45D2300713 CLIA NUMBER - ENVY IV

Laboratory Demographics

  • CLIA Code: 45D2300713
  • Facility Name: ENVY IV
  • Facility Address: 4070 STATE HIGHWAY 121 SUITE 412
    CARROLLTON, TX
    ZIP 75010
  • Facility Phone: 469 216-1102
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JAYOUNG JEONG
  • NPI Number: 1033982749
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D2300713
LAB Type Physician Office
Facility Name ENVY IV
Street 4070 STATE HIGHWAY 121 SUITE 412
City CARROLLTON
State TX
ZIP 75010
Phone 469 216-1102
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/14/2024
Certificate Expiration Date 3/13/2026
Facility Type Physician Office
Lab Director JAYOUNG JEONG

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