45D2326030 CLIA NUMBER - VITALEDGE DIAGNOSTICS

Laboratory Demographics

  • CLIA Code: 45D2326030
  • Facility Name: VITALEDGE DIAGNOSTICS
  • Facility Address: 1910 PACIFIC AVE, SUITE 2000 -1131
    DALLAS, TX
    ZIP 75201
  • Facility Phone: 609 410-9998
  • Facility Type: Independent
  • Facility Type: Certificate of Compliance
  • Lab Director: GLEN HANSEN
  • NPI Number: 1366330201
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 45D2326030
LAB Type Independent
Facility Name VITALEDGE DIAGNOSTICS
Street 1910 PACIFIC AVE, SUITE 2000 -1131
City DALLAS
State TX
ZIP 75201
Phone 609 410-9998
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 6/25/2025
Certificate Expiration Date 6/24/2027
Facility Type Independent
Lab Director GLEN HANSEN

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