45D2305957 CLIA NUMBER - MODERA CLINIC, PLLC (FRISCO)

Laboratory Demographics

  • CLIA Code: 45D2305957
  • Facility Name: MODERA CLINIC, PLLC (FRISCO)
  • Facility Address: 5575 FRISCO SQUARE BLVD STE 220
    FRISCO, TX
    ZIP 75034
  • Facility Phone: 469 920-2302
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TREVOR K. HUBER
  • NPI Number: 1063142115
  • Taxonomy: 207RG0100X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D2305957
LAB Type Physician Office
Facility Name MODERA CLINIC, PLLC (FRISCO)
Street 5575 FRISCO SQUARE BLVD STE 220
City FRISCO
State TX
ZIP 75034
Phone 469 920-2302
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/10/2024
Certificate Expiration Date 6/9/2026
Facility Type Physician Office
Lab Director TREVOR K. HUBER

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