45D2306181 CLIA NUMBER - MSK CLINIC LLC

Laboratory Demographics

  • CLIA Code: 45D2306181
  • Facility Name: MSK CLINIC LLC
  • Facility Address: 12129 RR 620 N , STE 610 ATTN CLIA LAB
    AUSTIN, TX
    ZIP 78750
  • Facility Phone: 512 900-7800
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. IBRAHIM MANSOUR
  • NPI Number: 1992400501
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D2306181
LAB Type Physician Office
Facility Name MSK CLINIC LLC
Street 12129 RR 620 N , STE 610 ATTN CLIA LAB
City AUSTIN
State TX
ZIP 78750
Phone 512 900-7800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/12/2024
Certificate Expiration Date 6/11/2026
Facility Type Physician Office
Lab Director DR. IBRAHIM MANSOUR

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