37D2174035 CLIA NUMBER - INGRID W JACKSON, MD, LLC

Laboratory Demographics

  • CLIA Code: 37D2174035
  • Facility Name: INGRID W JACKSON, MD, LLC
  • Facility Address: 740 SIGNAL RIDGE DR
    EDMOND, OK
    ZIP 73013
  • Facility Phone: 405 418-0125
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: INGRID W. JACKSON
  • NPI Number: 1205336187
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 37D2174035
LAB Type Physician Office
Facility Name INGRID W JACKSON, MD, LLC
Street 740 SIGNAL RIDGE DR
City EDMOND
State OK
ZIP 73013
Phone 405 418-0125
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/23/2023
Certificate Expiration Date 10/22/2025
Facility Type Physician Office
Lab Director INGRID W. JACKSON

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