CLIA lab
CLIA 45D1037921: Executive Medicine of Southlake
Southlake, TX. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 45D1037921 belongs to Executive Medicine of Southlake in Southlake, TX.
Certificate of Waiver, effective October 29, 2025, expires October 28, 2027.
Active in the CMS Provider of Services file posted October 16, 2026.
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
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Certificate
- Certificate type
- Certificate of Waiver
- Certificate effective
- October 29, 2025
- Certificate expiration
- October 28, 2027
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- March 8, 2005
- Facility type
- Physician office
- Ownership (control type)
- Proprietary
- Lab classification
- CLIA laboratory
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 45D1037921
- Lab name
- Executive Medicine of Southlake
- Address
- 2106 E State Highway 114 Suite 300, Southlake, TX 76092
- Phone
- (817) 552-4300
- Fax
- (817) 552-4301
Annual test volume the lab reported
- Waived tests
- 400
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
Other labs in Southlake, TX
- Acute Care and Family MedicineCertificate for Provider-Performed Microscopy Procedures, Physician office45D1007246
- Advanced Allergy & Asthma AssociatesCertificate of Waiver, Physician office45D2179463
- Alpha Men's HealthCertificate of Compliance, Other practitioner45D2295244
- Arbor PediatricsCertificate of Waiver, Physician office45D2206557
- Arise Recovery Centers SouthlakeCertificate of Waiver, Other45D2153375
- Atlantis Men's Health, PLLC DBA Elixir 360 HealthCertificate of Waiver, Physician office45D2330423
- Axis Surgery Center, LLCCertificate of Waiver, Ambulatory surgery center45D2211344
- BSW Southlake PediatricsCertificate of Waiver, Physician office45D2328211
- BSW Southlake Urgent CareCertificate of Waiver, Other45D2251077
- Baylor Scott & White Southlake Family MedicineCertificate of Waiver, Physician office45D0916018
Related
Questions
What is the CLIA number for Executive Medicine of Southlake in Southlake?
45D1037921, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Executive Medicine of Southlake hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 45D1037921 expire?
The CMS file lists October 28, 2027 as the certificate expiration date; the certificate took effect October 29, 2025.