45D2307045 CLIA NUMBER - COMMUNITYMED FAMILY CARE MANSFIELD

Laboratory Demographics

  • CLIA Code: 45D2307045
  • Facility Name: COMMUNITYMED FAMILY CARE MANSFIELD
  • Facility Address: 3020 E BROAD ST SUITE 100B
    MANSFIELD, TX
    ZIP 76063
  • Facility Phone: 469 759-7461
  • Facility Type: Other - URGENT CARE
  • Facility Type: Waiver
  • Lab Director: GREGORY GLOMQUIST
  • NPI Number: 1588317606
  • Taxonomy: 251B00000X - Case Management

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CLIA Record

Field Name Field Value
CLIA Number 45D2307045
LAB Type Other - URGENT CARE
Facility Name COMMUNITYMED FAMILY CARE MANSFIELD
Street 3020 E BROAD ST SUITE 100B
City MANSFIELD
State TX
ZIP 76063
Phone 469 759-7461
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/28/2024
Certificate Expiration Date 6/27/2026
Facility Type Other - URGENT CARE
Lab Director GREGORY GLOMQUIST

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