45D2305606 CLIA NUMBER - KINGSBROOK HEALTHCARE SERVICES PLLC

Laboratory Demographics

  • CLIA Code: 45D2305606
  • Facility Name: KINGSBROOK HEALTHCARE SERVICES PLLC
  • Facility Address: 6850 MAN HATTON BLVD SUITE 250
    FORT WORTH, TX
    ZIP 76120
  • Facility Phone: 682 301-1269
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TEMITAYO OSUNDE-SODIMU
  • NPI Number: 1225338684
  • Taxonomy: 253Z00000X - In Home Supportive Care

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CLIA Record

Field Name Field Value
CLIA Number 45D2305606
LAB Type Physician Office
Facility Name KINGSBROOK HEALTHCARE SERVICES PLLC
Street 6850 MAN HATTON BLVD SUITE 250
City FORT WORTH
State TX
ZIP 76120
Phone 682 301-1269
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/4/2024
Certificate Expiration Date 6/3/2026
Facility Type Physician Office
Lab Director TEMITAYO OSUNDE-SODIMU

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