45D0893093 CLIA NUMBER - JACK COUNTY MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 45D0893093
  • Facility Name: JACK COUNTY MEDICAL CLINIC
  • Facility Address: 215 CHISHOLM TRAIL
    JACKSBORO, TX
    ZIP 76458
  • Facility Phone: 940 567-6633
  • Facility Type: Other
  • Facility Type: Waiver
  • Lab Director: BRENT SHEPERD
  • NPI Number: 1417489956
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D0893093
LAB Type Other
Facility Name JACK COUNTY MEDICAL CLINIC
Street 215 CHISHOLM TRAIL
City JACKSBORO
State TX
ZIP 76458
Phone 940 567-6633
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/14/2024
Certificate Expiration Date 10/13/2026
Facility Type Other
Lab Director BRENT SHEPERD

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