45D0912758 CLIA NUMBER - JACKSON MEDICAL CLINIC OF EDNA

Laboratory Demographics

CLIA Number: 45D0912758

Facility Name: JACKSON MEDICAL CLINIC OF EDNA

Facility Address:
1013 A SOUTH WELLS
EDNA, TX
ZIP 77957
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Facility Phone Number: 512 782-5241

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1992748693

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D0912758
LAB Type	Other
Facility Name	JACKSON MEDICAL CLINIC OF EDNA
Street	1013 A SOUTH WELLS
City	EDNA
State	TX
ZIP	77957
Phone	512 782-5241
CertificateType	4
CertificateEffectiveDate	5/12/2024
CertificateExpirationDate	5/11/2026
FacilityType	Waiver

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