45D2306474 CLIA NUMBER - REVIVE PRIMARY CARE & MED SPA

Laboratory Demographics

  • CLIA Code: 45D2306474
  • Facility Name: REVIVE PRIMARY CARE & MED SPA
  • Facility Address: 2005 NE GREEN OAKS BLVD SUITE 150
    ARLINGTON, TX
    ZIP 76006
  • Facility Phone: 214 930-1659
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AIMAN SKOKR
  • NPI Number: 1669237798
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D2306474
LAB Type Physician Office
Facility Name REVIVE PRIMARY CARE & MED SPA
Street 2005 NE GREEN OAKS BLVD SUITE 150
City ARLINGTON
State TX
ZIP 76006
Phone 214 930-1659
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/18/2024
Certificate Expiration Date 6/17/2026
Facility Type Physician Office
Lab Director AIMAN SKOKR

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