45D0665741 CLIA NUMBER - JEFFERSON COUNTY SATELLITE MONTHLY CLN

Laboratory Demographics

CLIA Number: 45D0665741

Facility Name: JEFFERSON COUNTY SATELLITE MONTHLY CLN

Facility Address:
2748 VITERBO ROAD
BEAUMONT, TX
ZIP 77705
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Facility Phone Number: 409 724-7848

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1790256071

Taxonomy: 3416L0300X - Ambulance

CLIA Record

Field Name	Field Value
CLIA Number	45D0665741
LAB Type	Other
Facility Name	JEFFERSON COUNTY SATELLITE MONTHLY CLN
Street	2748 VITERBO ROAD
City	BEAUMONT
State	TX
ZIP	77705
Phone	409 724-7848
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024