45D2322585 CLIA NUMBER - AXENT DIAGNOSTICS, LLC

Laboratory Demographics

  • CLIA Code: 45D2322585
  • Facility Name: AXENT DIAGNOSTICS, LLC
  • Facility Address: 751 E SOUTHLAKE BLVD STE 122
    SOUTHLAKE, TX
    ZIP 76092
  • Facility Phone: 817 409-4114
  • Facility Type: Independent
  • Facility Type: Accreditation
  • Lab Director: CHESTER GWIN
  • NPI Number: 1508657578
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 45D2322585
LAB Type Independent
Facility Name AXENT DIAGNOSTICS, LLC
Street 751 E SOUTHLAKE BLVD STE 122
City SOUTHLAKE
State TX
ZIP 76092
Phone 817 409-4114
Certificate Type Certificate of Accreditation
Certificate Type Description This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.
Certificate Effective Date 4/23/2025
Certificate Expiration Date 4/22/2027
Facility Type Independent
Lab Director CHESTER GWIN

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