45D0477909 CLIA NUMBER - LAKE RAY HUBBARD PEDIATRIC CLINIC

Laboratory Demographics

  • CLIA Code: 45D0477909
  • Facility Name: LAKE RAY HUBBARD PEDIATRIC CLINIC
  • Facility Address: 862 W RUSK ST
    ROCKWALL, TX
    ZIP 75087
  • Facility Phone: 972 412-3034
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SUSAN SMART
  • NPI Number: 1427061308
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 45D0477909
LAB Type Physician Office
Facility Name LAKE RAY HUBBARD PEDIATRIC CLINIC
Street 862 W RUSK ST
City ROCKWALL
State TX
ZIP 75087
Phone 972 412-3034
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/18/2024
Certificate Expiration Date 12/17/2026
Facility Type Physician Office
Lab Director SUSAN SMART

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